Provider Demographics
NPI:1871104935
Name:YANOVICH, ALINA RYSHARDOVNA (PHARMD)
Entity type:Individual
Prefix:
First Name:ALINA
Middle Name:RYSHARDOVNA
Last Name:YANOVICH
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 1:711 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98363-5829
Mailing Address - Country:US
Mailing Address - Phone:303-257-5127
Mailing Address - Fax:
Practice Address - Street 1:621 S LINCOLN ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-6111
Practice Address - Country:US
Practice Address - Phone:360-452-9784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60886761183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist