Provider Demographics
NPI:1871612127
Name:STANKOVIC, MARKO (PHARMD)
Entity type:Individual
Prefix:
First Name:MARKO
Middle Name:
Last Name:STANKOVIC
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9401 SOUTHERN PINE BLVD
Mailing Address - Street 2:SUITE J
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-5598
Mailing Address - Country:US
Mailing Address - Phone:704-523-7731
Mailing Address - Fax:
Practice Address - Street 1:9401 SOUTHERN PINE BLVD
Practice Address - Street 2:SUITE J
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-5598
Practice Address - Country:US
Practice Address - Phone:704-523-7731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2010-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18793183500000X
VA0202209614183500000X
PARP440398183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist