Provider Demographics
NPI:1184950446
Name:DZIEKAN, INNA M (PHARMD)
Entity type:Individual
Prefix:DR
First Name:INNA
Middle Name:M
Last Name:DZIEKAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6008 CLEARWATER CIR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-4691
Mailing Address - Country:US
Mailing Address - Phone:502-708-1239
Mailing Address - Fax:
Practice Address - Street 1:701 VALLEY COLLEGE DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40272-2796
Practice Address - Country:US
Practice Address - Phone:502-933-3766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY014641183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist