Individual
TATYANA SHIYENKOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1555 NE DIVISION ST, GRESHAM, OR 97030-4271
(503) 666-9476
Mailing address
8411 NE WEBSTER ST, PORTLAND, OR 97220-4648
(503) 256-9091
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0016288
OR
Other
Enumeration date
10/24/2017
Last updated
10/24/2017
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