Provider Demographics
NPI:1811620792
Name:LISOVENKO, YURIY OLEGOVICH (PHARMD)
Entity Type:Individual
Prefix:
First Name:YURIY
Middle Name:OLEGOVICH
Last Name:LISOVENKO
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 1:12 E EMPIRE AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-1706
Mailing Address - Country:US
Mailing Address - Phone:509-325-0781
Mailing Address - Fax:
Practice Address - Street 1:12 E EMPIRE AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1706
Practice Address - Country:US
Practice Address - Phone:509-325-0781
Practice Address - Fax:509-325-0380
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP8075183500000X
WAPH60667890183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist