Provider Demographics
NPI:1396966115
Name:BARVINENKO, INNA
Entity type:Individual
Prefix:
First Name:INNA
Middle Name:
Last Name:BARVINENKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11101 SE 208TH ST. #1821
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-4153
Mailing Address - Country:US
Mailing Address - Phone:253-520-6661
Mailing Address - Fax:
Practice Address - Street 1:18016 72ND AVE S
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-1065
Practice Address - Country:US
Practice Address - Phone:425-251-0118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00067611183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician