Fantahun Yimam in Lubbock - Nutrition Support
Fantahun Yimam - NPI 1962534420
Fantahun Yimam is a Nutrition Support in Lubbock, Texas. Fantahun Yimam practices all healthcare services and medical treatments related to Nutrition Support. The NPI Number for Fantahun Yimam is 1962534420. The last update date is 2007-07-08.
Fantahun Yimam's current location address is 4605 102nd St, Lubbock, Texas. You can contact this provider via phone number 8067982291 and fax number 8067250305. The mailing address for Fantahun Yimam is 4605 102nd St, Lubbock, Texas. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Fantahun Yimam |
|---|---|
| Address | 4605 102nd St, Lubbock, Texas |
| Phone Number | 8067982291 |
| Fax Number | 8067250305 |
| Sole Proprietor | N |
| Credentials | PHARM.D. |
NPI Number Detail
| NPI Number | 1962534420 |
|---|---|
| Provider Enumeration Date | 2007-03-11 |
| Last Updated Date | 2007-07-08 |
Provider Mailing Address Detail
| Address | 4605 102nd St |
|---|---|
| City | Lubbock |
| State | Texas (TX) |
| Post Code | 794247406 |
| Phone Number | 8067982291 |
| Fax Number | 8067250305 |
Provider's Primary Taxonomy Detail
| Speciality | Nutrition Support |
|---|---|
| Taxonomy | 1835N1003X |
| Licence No | 36401 |
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Definition: A licensed pharmacist who has demonstrated specialized knowledge and skill in maintenance and/or restoration of optimal nutritional status, designing and modifying treatment according to patient needs. |
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What is the unique 10-digit identifier code issued to Fantahun Yimam by the Centers for Medicare & Medicaid Services?
The Fantahun Yimam has been assigned the NPI (National Provider Identifier) 1962534420 by the CMS (Centers for Medicare & Medicaid Services). This 10-digit code serves as a unique identification number for healthcare providers.
Could you provide the complete physical address where Fantahun Yimam is located?
The Fantahun Yimam is situated at the following address: 4605 102Nd St, Lubbock, TX, 794247406.
What is the Fantahun Yimam's area of specialization and corresponding taxonomy classification?
The Fantahun Yimam's specialty field is Nutrition Support, and it falls under the taxonomy code 1835N1003X, which categorizes healthcare providers based on their specialties.
On what date did the Fantahun Yimam receive the assignment of its 1962534420 from the Centers for Medicare & Medicaid Services?
The Fantahun Yimam was issued its 1962534420 by the Centers for Medicare & Medicaid Services on 2007-03-11.
When was the information related to Fantahun Yimam most recently updated or refreshed?
The details pertaining to the Fantahun Yimam, including its address, specialty, and other relevant information, were last updated or refreshed on 2007-07-08.