Provider Demographics
NPI:1114106135
Name:DOTCHEVA, PRESLAVA PEPOVA (RPH)
Entity Type:Individual
Prefix:
First Name:PRESLAVA
Middle Name:PEPOVA
Last Name:DOTCHEVA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5545 S BRAINARD AVE
Mailing Address - Street 2:
Mailing Address - City:COUNTRYSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-3542
Mailing Address - Country:US
Mailing Address - Phone:708-354-5302
Mailing Address - Fax:708-354-2733
Practice Address - Street 1:5545 S BRAINARD AVE
Practice Address - Street 2:
Practice Address - City:COUNTRYSIDE
Practice Address - State:IL
Practice Address - Zip Code:60525-3542
Practice Address - Country:US
Practice Address - Phone:708-354-5302
Practice Address - Fax:708-354-2733
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist