Provider Demographics
NPI:1366105942
Name:VUKOVIC, IVAN JOHN (PHARMD)
Entity type:Individual
Prefix:
First Name:IVAN
Middle Name:JOHN
Last Name:VUKOVIC
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:VUKOVIC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:16901 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-1137
Mailing Address - Country:US
Mailing Address - Phone:440-669-6997
Mailing Address - Fax:
Practice Address - Street 1:16901 LAKE AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-1137
Practice Address - Country:US
Practice Address - Phone:440-669-6997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH032367881835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist