MEDICARE: MEAGAN JESSICA PAWLAK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	S025849	AZ

General Provider Information

NPI Number	:	1639806979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEAGAN JESSICA PAWLAK

Provider Business Mailing Address
First Line	:	18440 N 68TH ST APT 2006
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85054-9135
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	20040 N 19TH AVE STE A
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85027-4256
Country	:	US
Telephone Number	:	623-869-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2022
Last Update Date	:	08/05/2022

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Directions to “ MEAGAN JESSICA PAWLAK ” Practice Location

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