Provider Demographics
NPI:1164781167
Name:TARGET
Entity Type:Organization
Organization Name:TARGET
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:LEMLEM
Authorized Official - Middle Name:
Authorized Official - Last Name:TEKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-854-9933
Mailing Address - Street 1:2800 SHILOH SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:TROTWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45426-2137
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2840 ASH RIDGE DR
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45434-5895
Practice Address - Country:US
Practice Address - Phone:937-751-6375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03325092183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty