Provider Demographics
NPI:1871853358
Name:NOVAK, AMANDA TOWERY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:TOWERY
Last Name:NOVAK
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 1:4875 OLD YORK RD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-8127
Mailing Address - Country:US
Mailing Address - Phone:803-323-2091
Mailing Address - Fax:
Practice Address - Street 1:4875 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-8127
Practice Address - Country:US
Practice Address - Phone:803-323-2091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-18
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13361183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist