Provider Demographics
NPI:1932654050
Name:PAVLOU, ANDREA P
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:P
Last Name:PAVLOU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 NORTH DR
Mailing Address - Street 2:
Mailing Address - City:MALBA
Mailing Address - State:NY
Mailing Address - Zip Code:11357-1030
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4 NORTH DR
Practice Address - Street 2:
Practice Address - City:MALBA
Practice Address - State:NY
Practice Address - Zip Code:11357-1030
Practice Address - Country:US
Practice Address - Phone:718-902-2376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY062091183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist