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NPI Code Detail

MEDICARE: JAMES RYAN NOVAK PHARM.D.

MEDICARE: JAMES RYAN NOVAK 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
1183500000XPharmacist117771MN

General Provider Information

NPI Number : 1962612135
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES RYAN NOVAK PHARM.D.
Provider Business Mailing Address
First Line : 4501 GRAND AVE
Second Line :
City : DULUTH
State : MN
Zip : 55807-2754
Country : US
Telephone Number : 218-628-2897
Fax Number : 218-624-5853
Provider Business Practice Location Address
First Line : 4501 GRAND AVE
Second Line :
City : DULUTH
State : MN
Zip : 55807-2754
Country : US
Telephone Number : 218-628-2897
Fax Number : 218-624-5853
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2007
Last Update Date : 10/24/2011

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