Provider Demographics
NPI:1285757674
Name:MIRKOVIC, ALEKSANDAR (RPH)
Entity type:Individual
Prefix:
First Name:ALEKSANDAR
Middle Name:
Last Name:MIRKOVIC
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1098 MANTUA PIKE
Mailing Address - Street 2:
Mailing Address - City:WENONAH
Mailing Address - State:NJ
Mailing Address - Zip Code:08090-1124
Mailing Address - Country:US
Mailing Address - Phone:856-464-1077
Mailing Address - Fax:856-415-0826
Practice Address - Street 1:1098 MANTUA PIKE
Practice Address - Street 2:
Practice Address - City:WENONAH
Practice Address - State:NJ
Practice Address - Zip Code:08090-1124
Practice Address - Country:US
Practice Address - Phone:856-464-1077
Practice Address - Fax:856-415-0826
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP443247183500000X
MI5302029928183500000X
NJ28RI03258600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist