Provider Demographics
NPI:1215932371
Name:NOVACK, BETTY IRENE (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:IRENE
Last Name:NOVACK
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:BETTY
Other - Middle Name:IRENE
Other - Last Name:ORRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2104
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85280-2104
Mailing Address - Country:US
Mailing Address - Phone:480-965-3338
Mailing Address - Fax:480-965-4416
Practice Address - Street 1:451 E UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-2000
Practice Address - Country:US
Practice Address - Phone:480-965-3338
Practice Address - Fax:480-965-4416
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS13276183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist