Provider Demographics
NPI:1285231779
Name:STOYKOV, MARIYAN KOSEV
Entity Type:Individual
Prefix:
First Name:MARIYAN
Middle Name:KOSEV
Last Name:STOYKOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 CARR ST
Mailing Address - Street 2:
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-3410
Mailing Address - Country:US
Mailing Address - Phone:773-290-9214
Mailing Address - Fax:
Practice Address - Street 1:13023 S LA GRANGE RD
Practice Address - Street 2:
Practice Address - City:PALOS PARK
Practice Address - State:IL
Practice Address - Zip Code:60464-1718
Practice Address - Country:US
Practice Address - Phone:708-361-2291
Practice Address - Fax:708-361-2759
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051303058183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist