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NPI Code Detail

MEDICARE: BOGDAN YAVORENKO PHARMD

MEDICARE: BOGDAN YAVORENKO 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
1183500000XPharmacist5302038894MI

General Provider Information

NPI Number : 1093346942
Entity Type Code : Individual
Provider Name (Legal Business Name) : BOGDAN YAVORENKO PHARMD
Provider Business Mailing Address
First Line : 10915 BELLEVILLE RD
Second Line :
City : VAN BUREN TWP
State : MI
Zip : 48111-1386
Country : US
Telephone Number : 734-697-4000
Fax Number :
Provider Business Practice Location Address
First Line : 10915 BELLEVILLE RD
Second Line :
City : VAN BUREN TWP
State : MI
Zip : 48111-1386
Country : US
Telephone Number : 734-697-4000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2020
Last Update Date : 01/30/2020

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Directions to “ BOGDAN YAVORENKO PHARMD” Practice Location

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