Provider Demographics
NPI:1275810707
Name:MILJEVIC, GORAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GORAN
Middle Name:
Last Name:MILJEVIC
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7151 WALTON ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2600
Mailing Address - Country:US
Mailing Address - Phone:815-397-4291
Mailing Address - Fax:815-397-4842
Practice Address - Street 1:7151 WALTON ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2600
Practice Address - Country:US
Practice Address - Phone:815-397-4291
Practice Address - Fax:815-397-4842
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-11
Last Update Date:2015-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051291295183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist