Provider Demographics
NPI:1275096596
Name:NOWAK, DIANA AGNIESZKA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:AGNIESZKA
Last Name:NOWAK
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 1:7101 E 128TH AVE
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80602-9101
Mailing Address - Country:US
Mailing Address - Phone:303-209-4339
Mailing Address - Fax:
Practice Address - Street 1:7101 E 128TH AVE
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80602-9101
Practice Address - Country:US
Practice Address - Phone:303-209-4339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0022047183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist