Provider Demographics
NPI:1851634687
Name:POLOVIC, RESTINA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:RESTINA
Middle Name:
Last Name:POLOVIC
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:RESTINA
Other - Middle Name:
Other - Last Name:VASIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5928 W VLIET ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-2165
Mailing Address - Country:US
Mailing Address - Phone:414-454-0000
Mailing Address - Fax:
Practice Address - Street 1:5928 W VLIET ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-2165
Practice Address - Country:US
Practice Address - Phone:414-454-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-29
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16607-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist