MEDICARE: DR. STEPHEN ANTHONY NOVICKI III PHARM.D, 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	03132432	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1467555193	OTHER	OH	NOT AVAILABLE

General Provider Information

NPI Number	:	1477135424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN ANTHONY NOVICKI III PHARM.D, RPH

Provider Business Mailing Address
First Line	:	204 FLINTWOOD DR
Second Line	:
City	:	MARIETTA
State	:	OH
Zip	:	45750-9359
Country	:	US
Telephone Number	:	412-443-8983
Fax Number	:

Provider Business Practice Location Address
First Line	:	131 3RD ST
Second Line	:
City	:	MARIETTA
State	:	OH
Zip	:	45750-3109
Country	:	US
Telephone Number	:	740-373-2961
Fax Number	:

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

Provider Enumeration Date	:	04/28/2021
Last Update Date	:	08/12/2022

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