Provider Demographics
NPI:1396840146
Name:NOVOCEUTICS WELLNESS SYSTMES
Entity Type:Organization
Organization Name:NOVOCEUTICS WELLNESS SYSTMES
Other - Org Name:NOVOCEUTICS
Other - Org Type:Other Name
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:P
Authorized Official - Last Name:MCNEIL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:801-936-6686
Mailing Address - Street 1:890 ROBINSON DR
Mailing Address - Street 2:
Mailing Address - City:NORTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84054-2933
Mailing Address - Country:US
Mailing Address - Phone:801-936-6686
Mailing Address - Fax:801-665-1250
Practice Address - Street 1:890 ROBINSON DR
Practice Address - Street 2:
Practice Address - City:NORTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84054-2933
Practice Address - Country:US
Practice Address - Phone:801-936-6686
Practice Address - Fax:801-665-1250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT58412321703333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy