Provider Demographics
NPI:1760785794
Name:EKKERT, OKSANA A (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:OKSANA
Middle Name:A
Last Name:EKKERT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:OKSANA
Other - Middle Name:A
Other - Last Name:RUDNEVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1322 LAKE WASHINGTON BLVD N
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-0703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2637 N PEARL ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98407-2416
Practice Address - Country:US
Practice Address - Phone:253-759-9271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-14
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60156549183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist