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General NPI Number Information
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NPI Number | 1124838222
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Entity Type | Individual
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Provider Name | RUTE TILAHUN
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Gender | Female
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Dates
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Enumeration Date | 01/10/2025
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 1040 GRAND AVE
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City | SAINT PAUL
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State | MN
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Zip | 55105-3001
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Country | US
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Telephone | 651-224-2155
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Fax |
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Provider Business Mailing Address
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Address Line | 503 OHIO ST APT 202
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City | SAINT PAUL
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State | MN
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Zip | 55107-2658
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Country | US
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Telephone | 601-259-7717
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 126780
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License Number State | MN
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