Provider Demographics
NPI:1861126401
Name:MIRKOVIC, DUSAN (PHARMACIST)
Entity type:Individual
Prefix:DR
First Name:DUSAN
Middle Name:
Last Name:MIRKOVIC
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 ROLAND LN
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-2155
Mailing Address - Country:US
Mailing Address - Phone:605-999-0471
Mailing Address - Fax:
Practice Address - Street 1:2791 DAKOTA AVE S
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:SD
Practice Address - Zip Code:57350-4411
Practice Address - Country:US
Practice Address - Phone:605-353-9513
Practice Address - Fax:605-353-9515
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD6972183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist