Provider Demographics
NPI:1477005155
Name:PAUVLINCH, PHILLIP (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:
Last Name:PAUVLINCH
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 INGLESIDE AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-1283
Mailing Address - Country:US
Mailing Address - Phone:724-622-8076
Mailing Address - Fax:
Practice Address - Street 1:1033 N HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-2409
Practice Address - Country:US
Practice Address - Phone:614-340-6776
Practice Address - Fax:614-340-6774
Is Sole Proprietor?:No
Enumeration Date:2016-10-28
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03132065183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03132065OtherOHIO PHARMACIST'S LICENSE NUMBER