Provider Demographics
NPI:1467757740
Name:KIYANITSA, VLADIMIR ANDREY (RPH)
Entity Type:Individual
Prefix:DR
First Name:VLADIMIR
Middle Name:ANDREY
Last Name:KIYANITSA
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 1:15543 LIVE OAK SPRINGS CANYON RD
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91387-4721
Mailing Address - Country:US
Mailing Address - Phone:207-409-6402
Mailing Address - Fax:
Practice Address - Street 1:1841 W AVENUE I
Practice Address - Street 2:SUITE 107
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-1471
Practice Address - Country:US
Practice Address - Phone:661-948-1818
Practice Address - Fax:661-948-1919
Is Sole Proprietor?:No
Enumeration Date:2011-01-18
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60762183500000X
MEPR5232183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist