Active NPI
Tizita Fekredengel
- Pharmacist
- Bridgeport, CT
National Provider Identifier
1477735223
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 10279
- Practice address
- 982 E Main St
Bridgeport, CT 06608-1913 - Phone
- (203) 696-3260
- NPI assigned
- Dec 4, 2007
- Last updated
- May 2, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 20 050809 | NY | |
| Pharmacist | 183500000X | 52841 | CA | |
| Pharmacist | 183500000X | 116424 | MN | |
| Pharmacist | 183500000X | 10279 | CT | Primary |
Addresses
Primary practice location
982 E Main St
Bridgeport, CT 06608-1913
Mailing address
153 Smith St
Port Chester, NY 10573-4614
Phone (510) 508-1552
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 |
|---|---|---|---|
| 10279 | CT | MD | Pharmacist |
| 116424 | MN | MD | Pharmacist |
| 20 050809 | NY | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1196726400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1493683200000",
"number": "1477735223",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "153 SMITH ST",
"city": "PORT CHESTER",
"state": "NY",
"postal_code": "105734614",
"telephone_number": "510-508-1552"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "982 E MAIN ST",
"city": "BRIDGEPORT",
"state": "CT",
"postal_code": "066081913",
"telephone_number": "203-696-3260"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FEKREDENGEL",
"first_name": "TIZITA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-12-04",
"last_updated": "2017-05-02",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "20 050809",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "52841",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "116424",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CT",
"license": "10279",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bridgeport, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.