Provider Demographics
NPI:1245513019
Name:NOWAKOWSKI, ELIZABETH ANN (PHARMACIST)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:NOWAKOWSKI
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 W FOREST HOME AVE
Mailing Address - Street 2:WALGREEN COMPANY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2527
Mailing Address - Country:US
Mailing Address - Phone:414-383-3414
Mailing Address - Fax:414-383-3588
Practice Address - Street 1:2410 W FOREST HOME AVE
Practice Address - Street 2:WALGREEN COMPANY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-2527
Practice Address - Country:US
Practice Address - Phone:414-383-3414
Practice Address - Fax:414-383-3588
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11763183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist