Provider Demographics
NPI:1093504912
Name:TILAHUN, TEGEST
Entity type:Individual
Prefix:
First Name:TEGEST
Middle Name:
Last Name:TILAHUN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 N NELLIS BLVD STE 7
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-5391
Mailing Address - Country:US
Mailing Address - Phone:702-331-6388
Mailing Address - Fax:702-331-7791
Practice Address - Street 1:765 N NELLIS BLVD STE 7
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-5391
Practice Address - Country:US
Practice Address - Phone:703-331-6388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV20171183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist