Provider Demographics
NPI:1396837076
Name:NOVAK, EDWARD ANDREW (BS PHARMACY)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:ANDREW
Last Name:NOVAK
Suffix:
Gender:M
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8025 SAWGRASS CT
Mailing Address - Street 2:
Mailing Address - City:ORLLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462
Mailing Address - Country:US
Mailing Address - Phone:708-460-8391
Mailing Address - Fax:
Practice Address - Street 1:5TH AND ROOSEVELT
Practice Address - Street 2:
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141
Practice Address - Country:US
Practice Address - Phone:708-460-8391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist