Provider Demographics
NPI:1124651641
Name:TEKLEAB, WINTANA T (PHARMD)
Entity type:Individual
Prefix:
First Name:WINTANA
Middle Name:T
Last Name:TEKLEAB
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 S EADS ST APT 314
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-2837
Mailing Address - Country:US
Mailing Address - Phone:813-841-0356
Mailing Address - Fax:
Practice Address - Street 1:1201 S EADS ST APT 314
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22202-2837
Practice Address - Country:US
Practice Address - Phone:813-841-0356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL526361835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist