Provider Demographics
NPI:1588815625
Name:TRIFUNOVIC, DUSANKA
Entity Type:Individual
Prefix:
First Name:DUSANKA
Middle Name:
Last Name:TRIFUNOVIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 S MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960
Mailing Address - Country:US
Mailing Address - Phone:215-257-9077
Mailing Address - Fax:215-453-0633
Practice Address - Street 1:218 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-2529
Practice Address - Country:US
Practice Address - Phone:215-257-9077
Practice Address - Fax:215-453-0633
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP033520L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist