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General NPI Number Information
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NPI Number | 1750667838
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Entity Type | Individual
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Provider Name | TINA ANN PAVELIC RPH
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Gender | Female
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Dates
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Enumeration Date | 11/02/2011
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Last Update Date | 02/23/2021
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Provider Practice Location Address
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Address Line | 635 N ARROWLEAF TRAIL
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City | SISTERS
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State | OR
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Zip | 97759
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Country | US
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Telephone | 541-549-6221
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Fax |
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Provider Business Mailing Address
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Address Line | 1575 NW WILD RYE CIR
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City | BEND
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State | OR
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Zip | 97703-5362
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Country | US
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Telephone | 541-848-7371
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 007112
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 7112
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License Number State | OR
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