Provider Demographics
NPI:1689381915
Name:KOSTYUCHENKO, YULIYA (CPHT)
Entity Type:Individual
Prefix:
First Name:YULIYA
Middle Name:
Last Name:KOSTYUCHENKO
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211507 E COCHRAN RD
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99337-6804
Mailing Address - Country:US
Mailing Address - Phone:509-820-0445
Mailing Address - Fax:
Practice Address - Street 1:1901 N STEPTOE ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7120
Practice Address - Country:US
Practice Address - Phone:509-783-3413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA61309748183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician