Provider Demographics
NPI:1801355490
Name:DOE, LIVINGSON PROSPER DJABAKU (PHARMD)
Entity type:Individual
Prefix:
First Name:LIVINGSON PROSPER
Middle Name:DJABAKU
Last Name:DOE
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 1:5011 E 18TH CT
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-1037
Mailing Address - Country:US
Mailing Address - Phone:509-901-7621
Mailing Address - Fax:
Practice Address - Street 1:2830 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-2528
Practice Address - Country:US
Practice Address - Phone:509-455-3736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60877867183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist