Healthcare Provider Details

I. General information

NPI: 1467898502
Provider Name (Legal Business Name): KATY LYNN NOWICKI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2013
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W FLORENCE ST
WINDSOR MO
65360-1127
US

IV. Provider business mailing address

713 DEERBROOK CIR APT D
KNOB NOSTER MO
65336-1281
US

V. Phone/Fax

Practice location:
  • Phone: 660-647-9921
  • Fax: 660-647-3617
Mailing address:
  • Phone: 856-745-0609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03499900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2013042211
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: