Provider Demographics
NPI:1497933410
Name:NOWAK, BEATA MALGORZATA (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:BEATA
Middle Name:MALGORZATA
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 1:7401 MINERAL POINT RD
Mailing Address - Street 2:SHOPKO PHARMACY
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-1703
Mailing Address - Country:US
Mailing Address - Phone:608-833-6622
Mailing Address - Fax:608-833-2275
Practice Address - Street 1:7401 MINERAL POINT RD
Practice Address - Street 2:SHOPKO PHARMACY
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-1703
Practice Address - Country:US
Practice Address - Phone:608-833-6622
Practice Address - Fax:608-833-2275
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14845183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist