Provider Demographics
NPI:1104968262
Name:NOWAKOWSKI, HENRIETTA V (RPH)
Entity type:Individual
Prefix:MRS
First Name:HENRIETTA
Middle Name:V
Last Name:NOWAKOWSKI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23354 LONGVIEW ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-2366
Mailing Address - Country:US
Mailing Address - Phone:313-565-7625
Mailing Address - Fax:
Practice Address - Street 1:23354 LONGVIEW ST
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-2366
Practice Address - Country:US
Practice Address - Phone:313-565-7625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI16874183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist