MEDICARE: ELIZABETH NOVELEN

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	S012510	AZ

General Provider Information

NPI Number	:	1508275561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH NOVELEN

Provider Business Mailing Address
First Line	:	5695 HIGHWAY 95 N
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86404-9646
Country	:	US
Telephone Number	:	928-764-3737
Fax Number	:	928-764-3740

Provider Business Practice Location Address
First Line	:	5695 HIGHWAY 95 N
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86404-9646
Country	:	US
Telephone Number	:	928-764-3737
Fax Number	:	928-764-3740

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

Provider Enumeration Date	:	08/04/2014
Last Update Date	:	08/04/2014

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Directions to “ ELIZABETH NOVELEN ” Practice Location

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