Provider Demographics
NPI:1528389608
Name:TESFAGIORGIS, TSEGAY (RPH)
Entity Type:Individual
Prefix:
First Name:TSEGAY
Middle Name:
Last Name:TESFAGIORGIS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3109 NE 11TH PL APT C
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-3483
Mailing Address - Country:US
Mailing Address - Phone:206-335-9931
Mailing Address - Fax:
Practice Address - Street 1:3116 NE SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98056-3337
Practice Address - Country:US
Practice Address - Phone:425-793-0787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-12
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60115015183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist