Provider Demographics
NPI:1972181378
Name:GAWLIK, KONSTANTIN VICTOROVICH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KONSTANTIN
Middle Name:VICTOROVICH
Last Name:GAWLIK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 PAT BOOKER RD
Mailing Address - Street 2:
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148-3437
Mailing Address - Country:US
Mailing Address - Phone:210-658-8011
Mailing Address - Fax:
Practice Address - Street 1:1836 PAT BOOKER RD
Practice Address - Street 2:
Practice Address - City:UNIVERSAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78148-3437
Practice Address - Country:US
Practice Address - Phone:210-658-8011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68851183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist