Provider Demographics
NPI:1619381688
Name:TEKLE, ABIY (PHARMD)
Entity Type:Individual
Prefix:
First Name:ABIY
Middle Name:
Last Name:TEKLE
Suffix:
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 1:6821 W HILLSBOROUGH AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-5003
Mailing Address - Country:US
Mailing Address - Phone:813-559-1010
Mailing Address - Fax:813-559-1200
Practice Address - Street 1:6821 W HILLSBOROUGH AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-5003
Practice Address - Country:US
Practice Address - Phone:813-559-1010
Practice Address - Fax:813-559-1200
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS48913183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS48913OtherPHARMACIST STATE LICENSE