Provider Demographics
NPI:1043513807
Name:MIHALEVICH, LAWRENCE J (RPH)
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:J
Last Name:MIHALEVICH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4051 COUNTRY MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53083-2580
Mailing Address - Country:US
Mailing Address - Phone:319-217-8494
Mailing Address - Fax:
Practice Address - Street 1:1029 N 14TH ST
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-3813
Practice Address - Country:US
Practice Address - Phone:920-458-7707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-15
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA15828183500000X
WI16165-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist