Provider Demographics
NPI:1588096150
Name:TSEGAYE, TESFAYE MELAKU (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TESFAYE
Middle Name:MELAKU
Last Name:TSEGAYE
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 1:1256 EL PASEO RD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001
Mailing Address - Country:US
Mailing Address - Phone:703-720-0807
Mailing Address - Fax:
Practice Address - Street 1:1356 BRYANT ST NE APT 2
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-1179
Practice Address - Country:US
Practice Address - Phone:703-720-0807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM7974183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist