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NPI Code Detail

MEDICARE: MRS. BETTY IRENE NOVACK PHARM. D.

MEDICARE: MRS. BETTY IRENE NOVACK PHARM. D.
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
1183500000XPharmacistS13276AZ

General Provider Information

NPI Number : 1215932371
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. BETTY IRENE NOVACK PHARM. D.
Provider Business Mailing Address
First Line : PO BOX 2104
Second Line :
City : TEMPE
State : AZ
Zip : 85280-2104
Country : US
Telephone Number : 480-965-3338
Fax Number : 480-965-4416
Provider Business Practice Location Address
First Line : 451 E UNIVERSITY DR
Second Line :
City : TEMPE
State : AZ
Zip : 85281-2000
Country : US
Telephone Number : 480-965-3338
Fax Number : 480-965-4416
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2005
Last Update Date : 07/08/2007

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