Provider Demographics
NPI:1851634687
Name:POLOVIC, RESTINA (RPH)
Entity type:Individual
Prefix:MRS
First Name:RESTINA
Middle Name:
Last Name:POLOVIC
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:RESTINA
Other - Middle Name:
Other - Last Name:VASIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:8240 S 88TH ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-9704
Mailing Address - Country:US
Mailing Address - Phone:414-975-8199
Mailing Address - Fax:
Practice Address - Street 1:201 JAMES ST
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-2562
Practice Address - Country:US
Practice Address - Phone:414-975-8199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-29
Last Update Date:2024-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051287012183500000X
WI16607-40183500000X
IN26019351A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist