Provider Demographics
NPI:1700461928
Name:TESHITE, MOHAMMED WOYESSO (PHARMD)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:WOYESSO
Last Name:TESHITE
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 1:460 NE BELLEVUE DR APT 209
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-7429
Mailing Address - Country:US
Mailing Address - Phone:612-501-0756
Mailing Address - Fax:
Practice Address - Street 1:629 HIGHWAY 20 N
Practice Address - Street 2:
Practice Address - City:HINES
Practice Address - State:OR
Practice Address - Zip Code:97738-9435
Practice Address - Country:US
Practice Address - Phone:541-573-1523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0017859183500000X
MN124528183500000X
NDRPH6166183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN124528OtherMINNESOTA STATE BOARD OF PHARMACY
ORRPH-0017859OtherOREGON STATE BOARD OF PHARMACY
NDRPH6166OtherNORTH DAKOTA STATE BOARD OF PHARMACY