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NPI Code Detail

MEDICARE: NATHAN TIKU WOLDE

MEDICARE: NATHAN TIKU WOLDE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist19649NV

General Provider Information

NPI Number : 1598280729
Entity Type Code : Individual
Provider Name (Legal Business Name) : NATHAN TIKU WOLDE
Provider Business Mailing Address
First Line : 7845 W FLAMINGO RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89147-4219
Country : US
Telephone Number : 702-871-1905
Fax Number :
Provider Business Practice Location Address
First Line : 7845 W FLAMINGO RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89147-4219
Country : US
Telephone Number : 702-871-1905
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2017
Last Update Date : 08/09/2017

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Directions to “ NATHAN TIKU WOLDE ” Practice Location

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