Provider Demographics
NPI:1194055285
Name:PAWLICKI, CYNTHIA ERIN
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ERIN
Last Name:PAWLICKI
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 1:100 S BEELINE HWY
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-4809
Mailing Address - Country:US
Mailing Address - Phone:928-474-1599
Mailing Address - Fax:
Practice Address - Street 1:100 S BEELINE HWY
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-4809
Practice Address - Country:US
Practice Address - Phone:928-474-1599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS12998183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist