Provider Demographics
NPI:1790374171
Name:TASIC-PANTIC, MIRJANA (RPH, CPH)
Entity Type:Individual
Prefix:
First Name:MIRJANA
Middle Name:
Last Name:TASIC-PANTIC
Suffix:
Gender:F
Credentials:RPH, CPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6267 BARTON CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-6544
Mailing Address - Country:US
Mailing Address - Phone:561-951-0824
Mailing Address - Fax:
Practice Address - Street 1:4900 LINTON BLVD STE 24
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-6687
Practice Address - Country:US
Practice Address - Phone:561-921-2025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS38383183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist