Provider Demographics
NPI:1649612938
Name:NOVOTNY, NICHOLAS ALLEN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:ALLEN
Last Name:NOVOTNY
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 1:7011 E SHEA BLVD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-5249
Mailing Address - Country:US
Mailing Address - Phone:480-948-6332
Mailing Address - Fax:480-607-0765
Practice Address - Street 1:7011 E SHEA BLVD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-5249
Practice Address - Country:US
Practice Address - Phone:480-948-6332
Practice Address - Fax:480-607-0765
Is Sole Proprietor?:No
Enumeration Date:2013-07-27
Last Update Date:2013-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS019914183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist