Provider Demographics
NPI:1215218417
Name:VYBOITCHENKO, OLGA (RPH)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:VYBOITCHENKO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2648 HADDASSAH DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-3068
Mailing Address - Country:US
Mailing Address - Phone:630-300-3875
Mailing Address - Fax:
Practice Address - Street 1:2648 HADDASSAH DR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-3068
Practice Address - Country:US
Practice Address - Phone:630-300-3875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051288851183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist