Provider Demographics
NPI:1386363117
Name:STANIMIROVIC, JOVANA
Entity type:Individual
Prefix:
First Name:JOVANA
Middle Name:
Last Name:STANIMIROVIC
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 1:11351 WOODGLEN DR APT 506
Mailing Address - Street 2:
Mailing Address - City:NORTH BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20852-6016
Mailing Address - Country:US
Mailing Address - Phone:202-560-4078
Mailing Address - Fax:
Practice Address - Street 1:4931 CORDELL AVE
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-2508
Practice Address - Country:US
Practice Address - Phone:240-802-2092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist