Basic Information
| Provider Information | |||||||||
| NPI: | 1528468261 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHEPA | ||||||||
| FirstName: | LIDIYA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14505 NE FOURTH PLAIN BOULEVARD | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986628845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3602582653 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14505 NE FOURTH PLAIN BOULEVARD | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98662 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604149602 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2014 | ||||||||
| LastUpdateDate: | 08/27/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P0018X | RPH0013404 | OR | N | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 183500000X | PH60328369 | WA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.