Provider Demographics
NPI:1447905450
Name:DERYAVKO, OLGA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:OLGA
Middle Name:
Last Name:DERYAVKO
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 1:91-501 EWA BEACH RD APT C
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-2972
Mailing Address - Country:US
Mailing Address - Phone:808-681-2477
Mailing Address - Fax:
Practice Address - Street 1:7034 ALAMO DOWNS PKWY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-4509
Practice Address - Country:US
Practice Address - Phone:808-681-2477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-17
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033.0134617183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT033.0134617OtherVERMONT PHARMACIST LICENSE