Provider Demographics
NPI:1366042087
Name:NOVAKOSKI, JAMES THOMAS
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:THOMAS
Last Name:NOVAKOSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 PRUDDEN ST UNIT 124
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48906-5385
Mailing Address - Country:US
Mailing Address - Phone:517-482-9149
Mailing Address - Fax:
Practice Address - Street 1:2925 TOWNE CENTRE BLVD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-5650
Practice Address - Country:US
Practice Address - Phone:517-482-1803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315114245183500000X
FLPS34483183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist