Provider Demographics
NPI:1659199719
Name:TECLE, METKEL
Entity type:Individual
Prefix:DR
First Name:METKEL
Middle Name:
Last Name:TECLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 E WOODLAWN RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-2349
Mailing Address - Country:US
Mailing Address - Phone:704-525-7291
Mailing Address - Fax:
Practice Address - Street 1:10012 WEISS WAY
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-0800
Practice Address - Country:US
Practice Address - Phone:704-321-2694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33416183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist