Provider Demographics
NPI:1174123368
Name:BESHIHA, TEFERA BERIE (PHARMACIST)
Entity type:Individual
Prefix:DR
First Name:TEFERA
Middle Name:BERIE
Last Name:BESHIHA
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 S COLORADO ST
Mailing Address - Street 2:
Mailing Address - City:LOCKHART
Mailing Address - State:TX
Mailing Address - Zip Code:78644-3949
Mailing Address - Country:US
Mailing Address - Phone:512-398-2364
Mailing Address - Fax:512-398-5555
Practice Address - Street 1:1904 S COLORADO ST
Practice Address - Street 2:
Practice Address - City:LOCKHART
Practice Address - State:TX
Practice Address - Zip Code:78644-3949
Practice Address - Country:US
Practice Address - Phone:512-398-2364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX46038183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist