Provider Demographics
NPI:1902178403
Name:TIRFE, ASSELEFETCH SHENKUTIE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ASSELEFETCH
Middle Name:SHENKUTIE
Last Name:TIRFE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3241 N MENOMONEE RIVER PKWY
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53222-3313
Mailing Address - Country:US
Mailing Address - Phone:414-771-9048
Mailing Address - Fax:
Practice Address - Street 1:6600 W STATE ST
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-2836
Practice Address - Country:US
Practice Address - Phone:414-476-5585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-31
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13196-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist