Provider Demographics
NPI:1235764515
Name:PAVLICEK, BRITTANY (PHARM D)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:PAVLICEK
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21615 S DIAMOND LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:MN
Mailing Address - Zip Code:55374-8893
Mailing Address - Country:US
Mailing Address - Phone:763-428-6392
Mailing Address - Fax:
Practice Address - Street 1:21615 S DIAMOND LAKE RD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:MN
Practice Address - Zip Code:55374-8893
Practice Address - Country:US
Practice Address - Phone:763-428-6392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-07
Last Update Date:2020-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN122773183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist