Provider Demographics
NPI:1467898502
Name:NOWICKI, KATY LYNN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KATY
Middle Name:LYNN
Last Name:NOWICKI
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 1:713 DEERBROOK CIR APT D
Mailing Address - Street 2:
Mailing Address - City:KNOB NOSTER
Mailing Address - State:MO
Mailing Address - Zip Code:65336-1281
Mailing Address - Country:US
Mailing Address - Phone:856-745-0609
Mailing Address - Fax:
Practice Address - Street 1:200 W FLORENCE ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:MO
Practice Address - Zip Code:65360-1127
Practice Address - Country:US
Practice Address - Phone:660-647-9921
Practice Address - Fax:660-647-3617
Is Sole Proprietor?:No
Enumeration Date:2013-05-16
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03499900183500000X
MO2013042211183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist