Provider Demographics
NPI:1194356303
Name:PAVLIK, LAUREN (RPH)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:PAVLIK
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 1:209 E 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-4114
Mailing Address - Country:US
Mailing Address - Phone:248-548-6180
Mailing Address - Fax:
Practice Address - Street 1:209 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-4114
Practice Address - Country:US
Practice Address - Phone:248-548-6180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315109259183500000X
MI5302042802183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist