Healthcare Provider Details

I. General information

NPI: 1184223265
Provider Name (Legal Business Name): SOLOMON AYALEW YIMER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2020
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4715 S ATLANTA RD SE
ATLANTA GA
30339-1531
US

IV. Provider business mailing address

107 KATHRYN DR
MARIETTA GA
30066-3417
US

V. Phone/Fax

Practice location:
  • Phone: 404-792-6980
  • Fax:
Mailing address:
  • Phone: 678-316-5765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH026422
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: