Provider Demographics
NPI:1063061539
Name:TILAHUN, RIGBE
Entity type:Individual
Prefix:
First Name:RIGBE
Middle Name:
Last Name:TILAHUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 CRANBROOK PARK
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-5412
Mailing Address - Country:US
Mailing Address - Phone:972-757-1584
Mailing Address - Fax:
Practice Address - Street 1:220 N 3RD ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-1326
Practice Address - Country:US
Practice Address - Phone:301-334-8182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-08
Last Update Date:2019-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56162183500000X
MD22770183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist