Provider Demographics
NPI:1881037232
Name:NOVICK, DAVID LEE (RPH)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LEE
Last Name:NOVICK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5142 EAGLE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-9690
Mailing Address - Country:US
Mailing Address - Phone:970-472-5849
Mailing Address - Fax:
Practice Address - Street 1:514 S GREELEY HWY
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82007-2852
Practice Address - Country:US
Practice Address - Phone:307-634-6662
Practice Address - Fax:307-634-6670
Is Sole Proprietor?:No
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2840183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist