Provider Demographics
NPI:1548582935
Name:PAVLOVICH, DENISE M (RPH)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:M
Last Name:PAVLOVICH
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 1:1405 S GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLES CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50616-3670
Mailing Address - Country:US
Mailing Address - Phone:641-228-7940
Mailing Address - Fax:641-228-7883
Practice Address - Street 1:1405 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:CHARLES CITY
Practice Address - State:IA
Practice Address - Zip Code:50616-3670
Practice Address - Country:US
Practice Address - Phone:641-228-7940
Practice Address - Fax:641-228-7883
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAP14809183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist