Provider Demographics
NPI:1639777048
Name:MALAVIA, SAJANI (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:SAJANI
Middle Name:
Last Name:MALAVIA
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 1:920 STATE ROAD 136
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-9254
Mailing Address - Country:US
Mailing Address - Phone:608-356-1779
Mailing Address - Fax:
Practice Address - Street 1:920 STATE ROAD 136
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-9254
Practice Address - Country:US
Practice Address - Phone:608-356-1779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051302803183500000X
WI19673-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist