Provider Demographics
NPI:1700456688
Name:PAWLI, MARJORIE B
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:B
Last Name:PAWLI
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 1:924 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49412-1419
Mailing Address - Country:US
Mailing Address - Phone:231-924-3790
Mailing Address - Fax:231-924-9136
Practice Address - Street 1:924 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:MI
Practice Address - Zip Code:49412-1419
Practice Address - Country:US
Practice Address - Phone:231-924-3790
Practice Address - Fax:231-924-9136
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5303012805183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician