Provider Demographics
NPI:1043510944
Name:KURKOV, DMITRIY VALERYEVICH (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:DMITRIY
Middle Name:VALERYEVICH
Last Name:KURKOV
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21301 STATE ROUTE 410 E
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-8468
Mailing Address - Country:US
Mailing Address - Phone:253-862-2533
Mailing Address - Fax:253-862-2173
Practice Address - Street 1:21301 STATE ROUTE 410 E
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-8468
Practice Address - Country:US
Practice Address - Phone:253-862-2533
Practice Address - Fax:253-862-2173
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 60144491183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist