Provider Demographics
NPI:1689045767
Name:DEYNEGA, IGOR (PHARM D)
Entity Type:Individual
Prefix:
First Name:IGOR
Middle Name:
Last Name:DEYNEGA
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1280 BROADROCK CT
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-2706
Mailing Address - Country:US
Mailing Address - Phone:216-469-7925
Mailing Address - Fax:
Practice Address - Street 1:1280 BROADROCK CT
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-2706
Practice Address - Country:US
Practice Address - Phone:216-469-7925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03234203183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist