MEDICARE: SELAMAWIT TEKLU PHARM D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP449024	PA

General Provider Information

NPI Number	:	1811352388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SELAMAWIT TEKLU PHARM D

Provider Business Mailing Address
First Line	:	138 STATE RD APT 117
Second Line	:
City	:	BENSALEM
State	:	PA
Zip	:	19020-7749
Country	:	US
Telephone Number	:	215-870-5546
Fax Number	:

Provider Business Practice Location Address
First Line	:	3260 N BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-5008
Country	:	US
Telephone Number	:	215-225-9704
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2015
Last Update Date	:	12/28/2015

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