Provider Demographics
NPI:1154061869
Name:KREVECHENKO, GANNA (PHARMD)
Entity Type:Individual
Prefix:
First Name:GANNA
Middle Name:
Last Name:KREVECHENKO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:KREVECHENKO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:513 5TH AVE W
Mailing Address - Street 2:
Mailing Address - City:GRAND MARAIS
Mailing Address - State:MN
Mailing Address - Zip Code:55604-3017
Mailing Address - Country:US
Mailing Address - Phone:218-877-8277
Mailing Address - Fax:218-877-8279
Practice Address - Street 1:513 5TH AVE W
Practice Address - Street 2:
Practice Address - City:GRAND MARAIS
Practice Address - State:MN
Practice Address - Zip Code:55604-3017
Practice Address - Country:US
Practice Address - Phone:218-877-8277
Practice Address - Fax:218-877-8279
Is Sole Proprietor?:No
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN125029183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist