Provider Demographics
NPI:1881953594
Name:TIGBHA CARE LLC
Entity type:Organization
Organization Name:TIGBHA CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:UMESH
Authorized Official - Middle Name:
Authorized Official - Last Name:GAJJALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-631-1453
Mailing Address - Street 1:903 ENGH RD
Mailing Address - Street 2:SUITE # A
Mailing Address - City:OMAK
Mailing Address - State:WA
Mailing Address - Zip Code:98841-9627
Mailing Address - Country:US
Mailing Address - Phone:509-422-1500
Mailing Address - Fax:509-422-1514
Practice Address - Street 1:903 ENGH RD
Practice Address - Street 2:SUITE # A
Practice Address - City:OMAK
Practice Address - State:WA
Practice Address - Zip Code:98841-9627
Practice Address - Country:US
Practice Address - Phone:509-422-1500
Practice Address - Fax:509-422-1514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-15
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8924213OtherFLU SPECIFIC MEDICARE PART B PROVIDER
WAG8924213OtherFLU SPECIFIC MEDICARE PART B PROVIDER