Active NPI
Fasil Demere Tsehayu
- Pharmacist
- Ardmore, OK
National Provider Identifier
1023735024
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 18451
- Practice address
- 1220 N Commerce St
Ardmore, OK 73401-1806 - Phone
- (580) 223-1041
- NPI assigned
- Oct 21, 2022
- Last updated
- Oct 21, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 63375 | TX | |
| Pharmacist | 183500000X | 18451 | OK | Primary |
Addresses
Primary practice location
1220 N Commerce St
Ardmore, OK 73401-1806
Mailing address
3744 W Buckingham Rd Apt 171
Garland, TX 75042-4723
Phone (469) 422-5343
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 63375 | TX | MD | Mental Health Counselor |
| 18451 | OK | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Oklahoma CVS Pharmacy LLC | Past | Accepting new patients | |
| Oklahoma CVS Pharmacy LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1666310400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1666310400000",
"number": "1023735024",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3744 W BUCKINGHAM RD APT 171",
"city": "GARLAND",
"state": "TX",
"postal_code": "750424723",
"telephone_number": "469-422-5343"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1220 N COMMERCE ST",
"city": "ARDMORE",
"state": "OK",
"postal_code": "734011806",
"telephone_number": "580-223-1041"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TSEHAYU",
"first_name": "FASIL",
"middle_name": "DEMERE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-10-21",
"last_updated": "2022-10-21",
"certification_date": "2022-10-20",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "63375",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OK",
"license": "18451",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ardmore, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.