Provider Demographics
NPI:1770850364
Name:NOVOTNY, JENNIFER ELIZABETH (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ELIZABETH
Last Name:NOVOTNY
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 1:1271 N SCANDIA DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-1305
Mailing Address - Country:US
Mailing Address - Phone:719-569-0012
Mailing Address - Fax:
Practice Address - Street 1:1520 W 4TH ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-1207
Practice Address - Country:US
Practice Address - Phone:719-404-0069
Practice Address - Fax:719-404-0072
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-26
Last Update Date:2011-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18140183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist