MEDICARE: DRAGANA JOVCIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PR5929	ME

General Provider Information

NPI Number	:	1508161282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DRAGANA JOVCIC

Provider Business Mailing Address
First Line	:	158 TAFT AVE
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04102-1211
Country	:	US
Telephone Number	:	207-828-7955
Fax Number	:

Provider Business Practice Location Address
First Line	:	665 ROOSEVELT TRL
Second Line	:
City	:	NAPLES
State	:	ME
Zip	:	04055-5322
Country	:	US
Telephone Number	:	207-693-3937
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2011
Last Update Date	:	01/11/2011

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