Provider Demographics
NPI:1801499900
Name:ABERRA, TIZAZU TESFAYE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TIZAZU
Middle Name:TESFAYE
Last Name:ABERRA
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:PO BOX 36106
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77236-6106
Mailing Address - Country:US
Mailing Address - Phone:832-450-0137
Mailing Address - Fax:
Practice Address - Street 1:4001 HOUSTON HWY
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-4708
Practice Address - Country:US
Practice Address - Phone:361-827-7275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65919183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty