Provider Demographics
NPI:1962033647
Name:MEHARI, TESFAGEBRIEL A (PHARMD)
Entity Type:Individual
Prefix:
First Name:TESFAGEBRIEL
Middle Name:A
Last Name:MEHARI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:TESFAGEBRIEL
Other - Middle Name:A
Other - Last Name:MEHARI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:5276 PINE AIRES DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-1346
Mailing Address - Country:US
Mailing Address - Phone:614-668-1157
Mailing Address - Fax:
Practice Address - Street 1:19993 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2591
Practice Address - Country:US
Practice Address - Phone:248-559-9810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302041134183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist