Provider Demographics
NPI:1013197839
Name:PILIPOVIC, PETRA A (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:PETRA
Middle Name:A
Last Name:PILIPOVIC
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 WICKAPECKO DR
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-4201
Mailing Address - Country:US
Mailing Address - Phone:732-776-6070
Mailing Address - Fax:
Practice Address - Street 1:1409 WICKAPECKO DR
Practice Address - Street 2:
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-4201
Practice Address - Country:US
Practice Address - Phone:732-776-6070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03157800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist