Provider Demographics
NPI:1487936118
Name:YILMA, TIGIST
Entity type:Individual
Prefix:
First Name:TIGIST
Middle Name:
Last Name:YILMA
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 1:9240 ROCKVILLE RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46234-2558
Mailing Address - Country:US
Mailing Address - Phone:317-209-1047
Mailing Address - Fax:317-209-1058
Practice Address - Street 1:9240 ROCKVILLE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46234-2558
Practice Address - Country:US
Practice Address - Phone:317-209-1047
Practice Address - Fax:317-209-1058
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26020997A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist