Provider Demographics
NPI:1851638605
Name:MARVANOVA, MARKETA (PHARMD, CGP, BCPP)
Entity Type:Individual
Prefix:DR
First Name:MARKETA
Middle Name:
Last Name:MARVANOVA
Suffix:
Gender:F
Credentials:PHARMD, CGP, BCPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1653 W CONGRESS PKWY
Mailing Address - Street 2:RUSH UNIVERSITY MEDICAL CENTER
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3833
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9501 S. KING DRIVE, DOUGLAS HALL 203-23
Practice Address - Street 2:CHICAGO STATE UNIVERSITY COLLEGE OF PHARMACY
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628
Practice Address - Country:US
Practice Address - Phone:773-821-2331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0512964051835P0018X
TN00000315571835P0018X
KY0157791835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist