Organization
ETEL PHARMACY
Active
Other names
Etel Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BISHAW DITAMO PHARMD (PHARMACIST IN CHARGE/PHARMACIST)
(651) 414-9547
Entity
Organization
Contact information
Practice address
2509 7TH ST W, SAINT PAUL, MN 55116-2837
(651) 785-8280
(612) 440-2238
Mailing address
2509 7TH ST W, SAINT PAUL, MN 55116-2837
(651) 785-8280
(612) 440-2238
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7295476
STATE TAX ID NUMBER
MN
Enumeration date
03/03/2021
Last updated
05/23/2021
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