Provider Demographics
NPI:1447423496
Name:TESFYAYE, ISAC (RPH)
Entity Type:Individual
Prefix:MR
First Name:ISAC
Middle Name:
Last Name:TESFYAYE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:ISAC
Other - Middle Name:
Other - Last Name:TESFAYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2962 S LONGHORN DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75134-2118
Mailing Address - Country:US
Mailing Address - Phone:972-228-6530
Mailing Address - Fax:972-228-5646
Practice Address - Street 1:2962 S LONGHORN DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75134-2118
Practice Address - Country:US
Practice Address - Phone:972-228-6530
Practice Address - Fax:972-228-5646
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35726183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist