MEDICARE: MIRJANA TASIC-PANTIC RPH, CPH

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	PS38383	FL

General Provider Information

NPI Number	:	1790374171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRJANA TASIC-PANTIC RPH, CPH

Provider Business Mailing Address
First Line	:	6267 BARTON CREEK CIR
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33463-6544
Country	:	US
Telephone Number	:	561-951-0824
Fax Number	:

Provider Business Practice Location Address
First Line	:	4900 LINTON BLVD STE 24
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-6687
Country	:	US
Telephone Number	:	561-921-2025
Fax Number	:

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

Provider Enumeration Date	:	01/11/2021
Last Update Date	:	01/11/2021

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