Provider Demographics
NPI:1629315585
Name:DORDEVIC, BILJANA
Entity Type:Individual
Prefix:
First Name:BILJANA
Middle Name:
Last Name:DORDEVIC
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 1:1455 STATE ROAD 436 STE 221
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-6514
Mailing Address - Country:US
Mailing Address - Phone:407-673-0788
Mailing Address - Fax:
Practice Address - Street 1:1455 STATE ROAD 436 STE 221
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-6514
Practice Address - Country:US
Practice Address - Phone:407-673-0788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-12
Last Update Date:2013-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41366183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist