Provider Demographics
NPI:1407128465
Name:RETA, NEBYELEUL ZEGEYE I (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:NEBYELEUL
Middle Name:ZEGEYE
Last Name:RETA
Suffix:I
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 1:1479 TIMBERLAKE RD
Mailing Address - Street 2:UNIT D
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117-3895
Mailing Address - Country:US
Mailing Address - Phone:651-497-1861
Mailing Address - Fax:
Practice Address - Street 1:7900 32ND ST N
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-4054
Practice Address - Country:US
Practice Address - Phone:651-855-0991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120683183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist