Provider Demographics
NPI:1043590516
Name:NOVAK, REESA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:REESA
Middle Name:
Last Name:NOVAK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72936-3726
Mailing Address - Country:US
Mailing Address - Phone:479-996-5522
Mailing Address - Fax:
Practice Address - Street 1:705 W CENTER ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:AR
Practice Address - Zip Code:72936-3726
Practice Address - Country:US
Practice Address - Phone:479-996-5522
Practice Address - Fax:479-996-5528
Is Sole Proprietor?:No
Enumeration Date:2011-08-27
Last Update Date:2011-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR09465183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist