Healthcare Provider Details

I. General information

NPI: 1396966115
Provider Name (Legal Business Name): INNA BARVINENKO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18016 72ND AVE S
KENT WA
98032-1065
US

IV. Provider business mailing address

11101 SE 208TH ST. #1821
KENT WA
98031-4153
US

V. Phone/Fax

Practice location:
  • Phone: 425-251-0118
  • Fax:
Mailing address:
  • Phone: 253-520-6661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA00067611
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: