Provider Demographics
NPI:1376221820
Name:PAVLICHEK, SAMUEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:PAVLICHEK
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 1:1711 EDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-3827
Mailing Address - Country:US
Mailing Address - Phone:770-366-2116
Mailing Address - Fax:
Practice Address - Street 1:1920 ALCOA HWY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1501
Practice Address - Country:US
Practice Address - Phone:865-305-9120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN455711835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy