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NPI Code Detail

MEDICARE: YURIY OLEGOVICH LISOVENKO PHARMD

MEDICARE: YURIY OLEGOVICH LISOVENKO PHARMD
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
1183500000XPharmacistP8075ID
2183500000XPharmacistPH60667890WA

General Provider Information

NPI Number : 1811620792
Entity Type Code : Individual
Provider Name (Legal Business Name) : YURIY OLEGOVICH LISOVENKO PHARMD
Provider Business Mailing Address
First Line : 12 E EMPIRE AVE
Second Line :
City : SPOKANE
State : WA
Zip : 99207-1706
Country : US
Telephone Number : 509-325-0781
Fax Number :
Provider Business Practice Location Address
First Line : 12 E EMPIRE AVE
Second Line :
City : SPOKANE
State : WA
Zip : 99207-1706
Country : US
Telephone Number : 509-325-0781
Fax Number : 509-325-0380
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2022
Last Update Date : 07/07/2022

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Directions to “ YURIY OLEGOVICH LISOVENKO PHARMD” Practice Location

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