Provider Demographics
NPI:1659617843
Name:PAVELKO, ANATOLE V (RPH)
Entity Type:Individual
Prefix:
First Name:ANATOLE
Middle Name:V
Last Name:PAVELKO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 MICHAEL WAY
Mailing Address - Street 2:
Mailing Address - City:CAMANO ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98282-6521
Mailing Address - Country:US
Mailing Address - Phone:360-547-6780
Mailing Address - Fax:
Practice Address - Street 1:930 MICHAEL WAY
Practice Address - Street 2:
Practice Address - City:CAMANO ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98282-6521
Practice Address - Country:US
Practice Address - Phone:360-547-6780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 00058683183500000X
NV05987183500000X
CA27498183500000X
FLPS6537183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist