Provider Demographics
NPI:1295011021
Name:NOWAK, PETER WILLIAM (PHARMD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:WILLIAM
Last Name:NOWAK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 MCCASTLEN ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-0903
Mailing Address - Country:US
Mailing Address - Phone:920-264-8936
Mailing Address - Fax:
Practice Address - Street 1:116 N MILITARY AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-3202
Practice Address - Country:US
Practice Address - Phone:920-498-3247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16326-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist