Provider Demographics
NPI:1003144403
Name:NOVEL, ZINA M (RPH)
Entity Type:Individual
Prefix:
First Name:ZINA
Middle Name:M
Last Name:NOVEL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4202 S CARRIER PKWY
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-3213
Mailing Address - Country:US
Mailing Address - Phone:972-266-7909
Mailing Address - Fax:972-266-7906
Practice Address - Street 1:4202 S CARRIER PKWY
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-3213
Practice Address - Country:US
Practice Address - Phone:972-266-7909
Practice Address - Fax:972-266-7906
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34114183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist