Pavilion Pharmacy

Primary specialty

PharmacyTaxonomy code 333600000X

License

13542 Issued in TX

Legal business name

PAVILION PHARMACY

Practice address

221 W Colorado Blvd
Suite 445
Dallas, TX 75208-2363

Phone

(214) 947-2435

Fax

(214) 947-2436

NPI assigned

Sep 9, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael Lieb

Title

President

Phone

(214) 947-7511

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1126224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1699769299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 W COLORADO BLVD",
            "address_2": "SUITE 445",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752082363",
            "telephone_number": "214-947-2435",
            "fax_number": "214-947-2436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 W COLORADO BLVD",
            "address_2": "SUITE 445",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752082363",
            "telephone_number": "214-947-2435",
            "fax_number": "214-947-2436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAVILION PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-09",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "LIEB",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "214-947-7511"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "TX",
            "license": "13542",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "143603",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP",
            "identifier": "4580684",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kevin J Pauza, MD
• Nirav Pavasia, M.D.
• Morgan Chappell Pavel
• C. S. Pavelka, MD
• Ryan Daniel Pavelka, PA-C
• Christina Pavillard, MOTR
• Amrutha Pavle, M.D
• William Pavlovsky, OTR, CAPS
• Stephanie Rae Svoboda Pawelek, FNP
• Jacqulyn Taylor Pawelski, APRN, AGACNP-BP

• Pharmacy in Dallas, TX
• Providers in Dallas, TX by specialty
• Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.