Provider Demographics
NPI:1730860958
Name:KORZHUK, LARISA (RPH)
Entity type:Individual
Prefix:
First Name:LARISA
Middle Name:
Last Name:KORZHUK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:LARISA
Other - Middle Name:
Other - Last Name:LOBANOVSKAYA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1010 SW 170TH AVENUE UNIT 203
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97003
Mailing Address - Country:US
Mailing Address - Phone:941-483-0367
Mailing Address - Fax:
Practice Address - Street 1:11190 SW BARNES RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225
Practice Address - Country:US
Practice Address - Phone:503-526-9121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0019539183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist