Provider Demographics
NPI:1801556626
Name:PAWLAK, JACQUELINE (PHARMD)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:PAWLAK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1646 N PROSPECT AVE APT 604
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-2411
Mailing Address - Country:US
Mailing Address - Phone:414-581-6412
Mailing Address - Fax:
Practice Address - Street 1:4798 S MOORLAND RD
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-7486
Practice Address - Country:US
Practice Address - Phone:262-207-0021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21215-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist