Provider Demographics
NPI:1093346942
Name:YAVORENKO, BOGDAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:BOGDAN
Middle Name:
Last Name:YAVORENKO
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 1:10915 BELLEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48111-1386
Mailing Address - Country:US
Mailing Address - Phone:734-697-4000
Mailing Address - Fax:
Practice Address - Street 1:10915 BELLEVILLE RD
Practice Address - Street 2:
Practice Address - City:VAN BUREN TWP
Practice Address - State:MI
Practice Address - Zip Code:48111-1386
Practice Address - Country:US
Practice Address - Phone:734-697-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302038894183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist