Provider Demographics
NPI:1194409276
Name:PAWLOWSKI, MATTHEW JUSTIN (PHARMD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JUSTIN
Last Name:PAWLOWSKI
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 1:3202 VIRTUOSO
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-0349
Mailing Address - Country:US
Mailing Address - Phone:623-271-0182
Mailing Address - Fax:
Practice Address - Street 1:1835 SUNNY CREST DR
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3616
Practice Address - Country:US
Practice Address - Phone:714-446-5101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAINT49542183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist