Provider Demographics
NPI:1194314740
Name:NOWAKOWSKI, NEIL (RP045445L)
Entity type:Individual
Prefix:
First Name:NEIL
Middle Name:
Last Name:NOWAKOWSKI
Suffix:
Gender:M
Credentials:RP045445L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-4541
Mailing Address - Country:US
Mailing Address - Phone:570-331-4011
Mailing Address - Fax:
Practice Address - Street 1:620 MARKET ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-4541
Practice Address - Country:US
Practice Address - Phone:570-331-4011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP045445L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist