Healthcare Provider Details

I. General information

NPI: 1811620792
Provider Name (Legal Business Name): YURIY OLEGOVICH LISOVENKO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12222 E SPRAGUE AVE
SPOKANE VALLEY WA
99206-5151
US

IV. Provider business mailing address

12 E EMPIRE AVE
SPOKANE WA
99207-1706
US

V. Phone/Fax

Practice location:
  • Phone: 509-924-4922
  • Fax: 509-922-8434
Mailing address:
  • Phone: 509-325-0781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60667890
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP8075
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: