Provider Demographics
NPI:1497360218
Name:VAINIKO, LISANDER (PHARMD)
Entity Type:Individual
Prefix:
First Name:LISANDER
Middle Name:
Last Name:VAINIKO
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 1:8026 W 99TH ST
Mailing Address - Street 2:
Mailing Address - City:PALOS HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60465-1451
Mailing Address - Country:US
Mailing Address - Phone:708-307-6324
Mailing Address - Fax:
Practice Address - Street 1:716 RIDGE RD
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-1612
Practice Address - Country:US
Practice Address - Phone:219-836-7978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-09
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26027888A183500000X
IL051301760183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist