Healthcare Provider Details

I. General information

NPI: 1851634687
Provider Name (Legal Business Name): RESTINA POLOVIC R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RESTINA VASIC R.PH.

II. Dates (important events)

Enumeration Date: 03/29/2013
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7605 NEW HAMPSHIRE AVE
HAMMOND IN
46323-2936
US

IV. Provider business mailing address

7605 NEW HAMPSHIRE AVE
HAMMOND IN
46323-2936
US

V. Phone/Fax

Practice location:
  • Phone: 414-975-8199
  • Fax: 219-845-3344
Mailing address:
  • Phone: 414-975-8199
  • Fax: 219-845-3344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051287012
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26019351A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16607-40
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16607
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: