Healthcare Provider Details

I. General information

NPI: 1528468261
Provider Name (Legal Business Name): LIDIYA CHEPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2014
Last Update Date: 08/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14505 NE FOURTH PLAIN BOULEVARD
VANCOUVER WA
98662
US

IV. Provider business mailing address

14505 NE FOURTH PLAIN BOULEVARD
VANCOUVER WA
98662-8845
US

V. Phone/Fax

Practice location:
  • Phone: 360-414-9602
  • Fax:
Mailing address:
  • Phone: 360-258-2653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60328369
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH0013404
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: