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General NPI Number Information
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NPI Number | 1861815144
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Entity Type | Individual
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Provider Name | DIMITRIY YUKHANOV
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Gender | Male
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Dates
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Enumeration Date | 01/22/2014
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Last Update Date | 12/16/2025
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Provider Practice Location Address
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Address Line | 5050 W BASELINE RD
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City | LAVEEN
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State | AZ
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Zip | 85339-7324
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Country | US
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Telephone | 602-703-8555
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Fax |
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Provider Business Mailing Address
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Address Line | 230 W ANGELA DR
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City | PHOENIX
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State | AZ
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Zip | 85023-6568
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Country | US
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Telephone | 602-703-8555
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | S019846
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License Number State | AZ
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