Provider Demographics
NPI:1386245363
Name:TEFERA, ABEBE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ABEBE
Middle Name:
Last Name:TEFERA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3728 REDWOOD CREEK LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-7061
Mailing Address - Country:US
Mailing Address - Phone:702-715-3241
Mailing Address - Fax:
Practice Address - Street 1:8401 ANDERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76120-3857
Practice Address - Country:US
Practice Address - Phone:817-276-9041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50488183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist