Provider Demographics
NPI:1841884376
Name:JOSIFOVSKI, GORDANA
Entity type:Individual
Prefix:
First Name:GORDANA
Middle Name:
Last Name:JOSIFOVSKI
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 1:932 MONTERREY CT APT A
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-3657
Mailing Address - Country:US
Mailing Address - Phone:219-779-6327
Mailing Address - Fax:
Practice Address - Street 1:52 LINCOLNWAY
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-5522
Practice Address - Country:US
Practice Address - Phone:219-462-4146
Practice Address - Fax:219-646-2578
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN67005952A183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183700000XPharmacy Service ProvidersPharmacy TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN67005952AOtherTHIRD PARTY