Provider Demographics
NPI:1700393337
Name:NOVAK, CANDICE MARIAH
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:MARIAH
Last Name:NOVAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 NORTHERN LIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-3705
Mailing Address - Country:US
Mailing Address - Phone:402-464-8302
Mailing Address - Fax:
Practice Address - Street 1:8300 NORTHERN LIGHTS DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-3705
Practice Address - Country:US
Practice Address - Phone:402-464-8302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE15845183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist