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NPI Code Detail

MEDICARE: NICHOLAS NOVAK PHARMD

MEDICARE: NICHOLAS NOVAK PHARMD
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
1183500000XPharmacist79602CA

General Provider Information

NPI Number : 1740753409
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICHOLAS NOVAK PHARMD
Provider Business Mailing Address
First Line : 7044 CAMINO DEGRAZIA UNIT 227
Second Line :
City : SAN DIEGO
State : CA
Zip : 92111-7813
Country : US
Telephone Number : 586-482-0143
Fax Number :
Provider Business Practice Location Address
First Line : 3222 UNIVERSITY AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92104-2010
Country : US
Telephone Number : 586-482-0143
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2019
Last Update Date : 12/23/2022

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Directions to “ NICHOLAS NOVAK PHARMD” Practice Location

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