Active NPI
Fantahun Yimam, PHARM.D.
- Nutrition Support Pharmacist
- Lubbock, TX
National Provider Identifier
1962534420
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nutrition Support Pharmacist
- License
- 36401
- Practice address
- 3615 19TH St
Lubbock, TX 79410-1203 - Phone
- (806) 725-0419
- Fax
- (806) 725-0305
- NPI assigned
- Mar 11, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutrition Support Pharmacist | 1835N1003X | 36401 | TX | Primary |
Addresses
Primary practice location
3615 19TH St
Lubbock, TX 79410-1203
Mailing address
4605 102ND St
Lubbock, TX 79424-7406
Phone (806) 798-2291
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36401 | TX | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173571200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1962534420",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4605 102ND ST",
"city": "LUBBOCK",
"state": "TX",
"postal_code": "794247406",
"telephone_number": "806-798-2291",
"fax_number": "806-725-0305"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3615 19TH ST",
"city": "LUBBOCK",
"state": "TX",
"postal_code": "794101203",
"telephone_number": "806-725-0419",
"fax_number": "806-725-0305"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YIMAM",
"first_name": "FANTAHUN",
"name_prefix": "Dr.",
"credential": "PHARM.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1835N1003X",
"taxonomy_group": "",
"desc": "Pharmacist, Nutrition Support",
"state": "TX",
"license": "36401",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lubbock, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.