Provider Demographics
NPI:1518567304
Name:RADOSEVIC, ILVANA (PHARMD)
Entity Type:Individual
Prefix:
First Name:ILVANA
Middle Name:
Last Name:RADOSEVIC
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-1765
Mailing Address - Country:US
Mailing Address - Phone:978-825-0845
Mailing Address - Fax:978-825-0898
Practice Address - Street 1:450 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-1765
Practice Address - Country:US
Practice Address - Phone:978-825-0845
Practice Address - Fax:978-825-0898
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH233338183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist