MEDICARE: LISA YURECHKO 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
1	183500000X	Pharmacist	RP440229	PA

General Provider Information

NPI Number	:	1134723414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA YURECHKO PHARMD

Provider Business Mailing Address
First Line	:	302 BALSA DR
Second Line	:
City	:	WEXFORD
State	:	PA
Zip	:	15090-6329
Country	:	US
Telephone Number	:	724-971-8198
Fax Number	:

Provider Business Practice Location Address
First Line	:	1805 WILMINGTON RD
Second Line	:
City	:	NEW CASTLE
State	:	PA
Zip	:	16105-1924
Country	:	US
Telephone Number	:	724-656-9185
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/26/2020
Last Update Date	:	11/26/2020

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