Provider Demographics
NPI:1598033466
Name:PAVLIK, LAURA LYNNE (PHARMD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LYNNE
Last Name:PAVLIK
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 1:901 N ANKENY BLVD
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-4002
Mailing Address - Country:US
Mailing Address - Phone:515-964-3952
Mailing Address - Fax:515-964-3657
Practice Address - Street 1:901 N ANKENY BLVD
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-4002
Practice Address - Country:US
Practice Address - Phone:515-964-3952
Practice Address - Fax:515-964-3657
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist