Provider Demographics
NPI:1013775030
Name:BARICEVIC, IVANA KARMEN
Entity Type:Individual
Prefix:
First Name:IVANA
Middle Name:KARMEN
Last Name:BARICEVIC
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 1:4239 SW 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4140
Mailing Address - Country:US
Mailing Address - Phone:503-453-7082
Mailing Address - Fax:
Practice Address - Street 1:9159 SE 82ND AVE
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-3761
Practice Address - Country:US
Practice Address - Phone:503-771-0274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0019547183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist