Provider Demographics
NPI:1164707857
Name:NOVAK, DANA LYNN (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:LYNN
Last Name:NOVAK
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38127-6005
Mailing Address - Country:US
Mailing Address - Phone:901-357-5364
Mailing Address - Fax:901-357-0884
Practice Address - Street 1:3100 THOMAS ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38127-6005
Practice Address - Country:US
Practice Address - Phone:901-357-5364
Practice Address - Fax:901-357-0884
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8820183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist