MEDICARE: DIANA KOVACEVIC PHARM.D

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	28RI03157700	NJ
2	183500000X	Pharmacist	03328965	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972877181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA KOVACEVIC PHARM.D

Provider Business Mailing Address
First Line	:	2093 ROUTE 130 N
Second Line	:
City	:	BURLINGTON
State	:	NJ
Zip	:	08016-9748
Country	:	US
Telephone Number	:	609-499-5781
Fax Number	:	609-499-5786

Provider Business Practice Location Address
First Line	:	2093 ROUTE 130 N
Second Line	:
City	:	BURLINGTON
State	:	NJ
Zip	:	08016-9748
Country	:	US
Telephone Number	:	609-499-5781
Fax Number	:	609-499-5786

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

Provider Enumeration Date	:	03/06/2012
Last Update Date	:	03/06/2012

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