Tewodros Gemeda
Individual provider Active NPI Pharmacist · Hilltop, MN
NPI 1609500487 · NPPES record last updated Jul 15, 2022
Key facts
- NPI
- 1609500487
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 118646 (MN)
- Practice address
- 4880 Central Ave NE
Hilltop, MN 55421-2630 - Phone
- (763) 571-7195
- NPI assigned
- Jul 15, 2022
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 118646 | MN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past |
Accepting new patients | |
| Walgreen Co | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 118646 | MN | Yes |
Addresses
Primary practice location
4880 Central Ave NE
Hilltop, MN 55421-2630
Mailing address
4880 Central Ave NE
Hilltop, MN 55421-2630
Phone (763) 571-7195
Other providers in Hilltop, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 15, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.