Healthcare Provider Details

I. General information

NPI: 1053721720
Provider Name (Legal Business Name): DANIEL NOWAK RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2014
Last Update Date: 05/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7340 W CENTRAL AVE
TOLEDO OH
43617-1121
US

IV. Provider business mailing address

8740 N STONE MILL RD
SYLVANIA OH
43560-9832
US

V. Phone/Fax

Practice location:
  • Phone: 419-843-8310
  • Fax: 419-843-8365
Mailing address:
  • Phone: 419-843-8310
  • Fax: 419-843-8365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number03319975
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: