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General NPI Number Information
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NPI Number | 1386859551
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Entity Type | Individual
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Provider Name | STACEY L NOVOTNY CPHT
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Gender | Female
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2005 W. BROADWAY
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City | PRINCETON
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State | IN
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Zip | 47670
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Country | US
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Telephone | 812-386-7672
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Fax | 812-386-5155
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Provider Business Mailing Address
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Address Line | 9810 S. JOY LANE
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City | HAUBSTADT
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State | IN
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Zip | 47639
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Country | US
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Telephone | 812-768-5248
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 6700258A
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License Number State | IN
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