Individual
TIZITA FEKREDENGEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
982 E MAIN ST, BRIDGEPORT, CT 06608-1913
(203) 696-3260
Mailing address
153 SMITH ST, PORT CHESTER, NY 10573-4614
(510) 508-1552
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
10279
CT
183500000X
Pharmacist
116424
MN
183500000X
Pharmacist
20 050809
NY
183500000X
Pharmacist
52841
CA
Other
Enumeration date
12/04/2007
Last updated
05/02/2017
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