MEDICARE: MRS. HENRIETTA V. NOWAKOWSKI RPH

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	16874	MI

General Provider Information

NPI Number	:	1104968262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HENRIETTA V. NOWAKOWSKI RPH

Provider Business Mailing Address
First Line	:	23354 LONGVIEW ST
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-2366
Country	:	US
Telephone Number	:	313-565-7625
Fax Number	:

Provider Business Practice Location Address
First Line	:	23354 LONGVIEW ST
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-2366
Country	:	US
Telephone Number	:	313-565-7625
Fax Number	:

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

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	07/08/2007

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