Provider Demographics
NPI:1093989592
Name:TEKLE, MOGES K (VA PHARMD)
Entity Type:Individual
Prefix:MR
First Name:MOGES
Middle Name:K
Last Name:TEKLE
Suffix:
Gender:M
Credentials:VA PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2567 COWAN BLVD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-8440
Mailing Address - Country:US
Mailing Address - Phone:540-479-1405
Mailing Address - Fax:
Practice Address - Street 1:2567 COWAN BLVD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-8440
Practice Address - Country:US
Practice Address - Phone:540-479-1405
Practice Address - Fax:540-370-8990
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02022063861835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist