Provider Demographics
NPI:1568272664
Name:MULUGETA, TSIGEREDA
Entity type:Individual
Prefix:
First Name:TSIGEREDA
Middle Name:
Last Name:MULUGETA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3747 W NELLIS AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-0685
Mailing Address - Country:US
Mailing Address - Phone:559-942-1576
Mailing Address - Fax:
Practice Address - Street 1:3747 W NELLIS AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-0685
Practice Address - Country:US
Practice Address - Phone:559-942-1576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89454183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist