Provider Demographics
NPI:1700354487
Name:FUFA, TEMESGEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TEMESGEN
Middle Name:
Last Name:FUFA
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 1:3474 ANDREW JACKSON DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30021-1235
Mailing Address - Country:US
Mailing Address - Phone:678-900-0600
Mailing Address - Fax:
Practice Address - Street 1:515 N HOUSTON RD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-8844
Practice Address - Country:US
Practice Address - Phone:478-273-6996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-11
Last Update Date:2018-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH030678183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist