Provider Demographics
NPI:1437360450
Name:PETROVS, VICTOR (RPH)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:
Last Name:PETROVS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3828 E IONA TER
Mailing Address - Street 2:
Mailing Address - City:CUDAHY
Mailing Address - State:WI
Mailing Address - Zip Code:53110-2720
Mailing Address - Country:US
Mailing Address - Phone:414-769-6646
Mailing Address - Fax:
Practice Address - Street 1:3828 E IONA TER
Practice Address - Street 2:
Practice Address - City:CUDAHY
Practice Address - State:WI
Practice Address - Zip Code:53110-2720
Practice Address - Country:US
Practice Address - Phone:414-769-6646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9151-040183500000X
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist