Individual
LARISA AVRAMOVNA GAVRILYUK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14061 LUDLOW ST, OAK PARK, MI 48237-1352
(248) 854-4302
Mailing address
26020 COOLIDGE HWY, HUNTINGTON WOODS, MI 48070-1415
(248) 545-8020
(248) 582-3794
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5303008597
PHARMACY TECHNICIAN LICENSE
MI
Enumeration date
02/28/2022
Last updated
02/28/2022
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