Provider Demographics
NPI:1487258075
Name:MIRKOVA, STOYANKA (RPH)
Entity type:Individual
Prefix:
First Name:STOYANKA
Middle Name:
Last Name:MIRKOVA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 NORTH RD UNIT 221
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-1450
Mailing Address - Country:US
Mailing Address - Phone:978-729-2293
Mailing Address - Fax:
Practice Address - Street 1:336 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01850-2409
Practice Address - Country:US
Practice Address - Phone:978-452-7165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH233984183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist