Provider Demographics
NPI:1013649730
Name:GAI, PAVANI
Entity type:Individual
Prefix:
First Name:PAVANI
Middle Name:
Last Name:GAI
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 1:5757 WHITMORE LAKE ROAD
Mailing Address - Street 2:STE 100
Mailing Address - City:48307
Mailing Address - State:MI
Mailing Address - Zip Code:48307
Mailing Address - Country:US
Mailing Address - Phone:810-229-9772
Mailing Address - Fax:
Practice Address - Street 1:5757 WHITMORE LAKE ROAD
Practice Address - Street 2:STE 100
Practice Address - City:48307
Practice Address - State:MI
Practice Address - Zip Code:48307
Practice Address - Country:US
Practice Address - Phone:810-229-9772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302045828183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1975017OtherCVS