Provider Demographics
NPI:1760478556
Name:ITEBEJAC, IVAN SAVA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:SAVA
Last Name:ITEBEJAC
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9652 HORNE LN
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-6280
Mailing Address - Country:US
Mailing Address - Phone:239-992-3682
Mailing Address - Fax:239-992-3682
Practice Address - Street 1:3033 WINKLER AVENUE EXT
Practice Address - Street 2:PHARMACY SERVICE FM VAOPC (119FM)
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33916-9413
Practice Address - Country:US
Practice Address - Phone:239-939-3939
Practice Address - Fax:239-931-6109
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS37547183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist