Provider Demographics
NPI:1609129741
Name:TSEGAYE, FERGENET (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:FERGENET
Middle Name:
Last Name:TSEGAYE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28409 18TH AVE S APT C102
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-3294
Mailing Address - Country:US
Mailing Address - Phone:206-355-5834
Mailing Address - Fax:
Practice Address - Street 1:2353 130TH AVE NE STE 100
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-1759
Practice Address - Country:US
Practice Address - Phone:425-885-6685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60283552183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist