Active NPI
Eyasu Teshale
- Pharmacist
- El Paso, TX
National Provider Identifier
1740880384
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 56058
- Practice address
- 12236 Montana Ave
El Paso, TX 79938-4851 - Phone
- (915) 255-4038
- NPI assigned
- Oct 30, 2020
- Last updated
- Oct 30, 2020
- 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 | PS52862 | FL | |
| Pharmacist | 183500000X | 56058 | TX | Primary |
Addresses
Primary practice location
12236 Montana Ave
El Paso, TX 79938-4851
Mailing address
12236 Montana Ave
El Paso, TX 79938-4851
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 |
|---|---|---|---|
| 56058 | TX | MD | Clinical Social Worker |
| PS52862 | FL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604016000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604016000000",
"number": "1740880384",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12236 MONTANA AVE",
"city": "EL PASO",
"state": "TX",
"postal_code": "799384851"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12236 MONTANA AVE",
"city": "EL PASO",
"state": "TX",
"postal_code": "799384851",
"telephone_number": "915-255-4038"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TESHALE",
"first_name": "EYASU",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-10-30",
"last_updated": "2020-10-30",
"certification_date": "2020-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS52862",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "56058",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in El Paso, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.