Provider Demographics
NPI:1437745593
Name:GARVONIC, ELAINA NICOLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ELAINA
Middle Name:NICOLE
Last Name:GARVONIC
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 1:46830 GADWALL DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-3209
Mailing Address - Country:US
Mailing Address - Phone:865-738-7688
Mailing Address - Fax:
Practice Address - Street 1:5990 SASHABAW RD
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-3154
Practice Address - Country:US
Practice Address - Phone:248-922-3704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53152217711835P0018X
MI53024130851835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist