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General NPI Number Information
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NPI Number | 1396244190
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Entity Type | Individual
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Provider Name | STANKA PERVITIC
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Gender | Female
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Dates
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Enumeration Date | 02/07/2018
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Last Update Date | 02/07/2018
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Provider Practice Location Address
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Address Line | 4400 EUCLID AVE
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City | CLEVELAND
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State | OH
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Zip | 44103-3734
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Country | US
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Telephone | 216-325-9300
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Fax |
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Provider Business Mailing Address
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Address Line | 10507 LAKE AVE APT 108
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City | CLEVELAND
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State | OH
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Zip | 44102-1268
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Country | US
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Telephone | 440-670-5494
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 03129258
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License Number State | OH
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