MEDICARE: NOVOCEUTICS WELLNESS SYSTMES

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	333600000X	Pharmacy	58412321703	UT

General Provider Information

NPI Number	:	1396840146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVOCEUTICS WELLNESS SYSTMES

Provider Business Mailing Address
First Line	:	890 ROBINSON DR
Second Line	:
City	:	NORTH SALT LAKE
State	:	UT
Zip	:	84054-2933
Country	:	US
Telephone Number	:	801-936-6686
Fax Number	:	801-665-1250

Provider Business Practice Location Address
First Line	:	890 ROBINSON DR
Second Line	:
City	:	NORTH SALT LAKE
State	:	UT
Zip	:	84054-2933
Country	:	US
Telephone Number	:	801-936-6686
Fax Number	:	801-665-1250

Authorized Official
Title or Position	:	PIC
Name	:	MR. FRANK P MCNEIL
Credential	:	RPH
Telephone Number	:	801-936-6686

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	08/22/2020

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