Provider Demographics
NPI:1548613714
Name:PAVILACK, MELISSA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:PAVILACK
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 1:42 JARED CT
Mailing Address - Street 2:
Mailing Address - City:SLATE HILL
Mailing Address - State:NY
Mailing Address - Zip Code:10973-3710
Mailing Address - Country:US
Mailing Address - Phone:845-551-3913
Mailing Address - Fax:
Practice Address - Street 1:42 JARED CT
Practice Address - Street 2:
Practice Address - City:SLATE HILL
Practice Address - State:NY
Practice Address - Zip Code:10973-3710
Practice Address - Country:US
Practice Address - Phone:845-551-3913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060485183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist