Healthcare Provider Details

I. General information

NPI: 1831512250
Provider Name (Legal Business Name): TIGIST TIKU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2014
Last Update Date: 05/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7421 W THUNDERBIRD RD
PEORIA AZ
85381
US

IV. Provider business mailing address

7421 W THUNDERBIRD RD
PEORIA AZ
85381-5036
US

V. Phone/Fax

Practice location:
  • Phone: 602-627-9852
  • Fax:
Mailing address:
  • Phone: 602-627-9852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS014464
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: