1952733164 NPI number — DR. MARIJA MIKULSKIS CAVANA PHARMD, RPH

Table of content: DR. MARIJA MIKULSKIS CAVANA PHARMD, RPH (NPI 1952733164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952733164 NPI number — DR. MARIJA MIKULSKIS CAVANA PHARMD, RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAVANA
Provider First Name:
MARIJA
Provider Middle Name:
MIKULSKIS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD, RPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952733164
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11109 US HIGHWAY 15 501
Provider Second Line Business Mailing Address:
UNIT 1804
Provider Business Mailing Address City Name:
ABERDEEN
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28315-2366
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-692-3048
Provider Business Mailing Address Fax Number:
910-692-3321

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11109 US HIGHWAY 15 501
Provider Second Line Business Practice Location Address:
UNIT 1804
Provider Business Practice Location Address City Name:
ABERDEEN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28315-2366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-692-3048
Provider Business Practice Location Address Fax Number:
910-692-3321
Provider Enumeration Date:
07/30/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  22495 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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