Provider Demographics
NPI:1972170942
Name:NOVAK, KIMBERLY JO (PHARMD, BCPS, BCPPS)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:JO
Last Name:NOVAK
Suffix:
Gender:F
Credentials:PHARMD, BCPS, BCPPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 CHILDRENS DR
Mailing Address - Street 2:DEPARTMENT OF PHARMACY
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-2639
Mailing Address - Country:US
Mailing Address - Phone:614-722-2199
Mailing Address - Fax:614-722-2189
Practice Address - Street 1:700 CHILDRENS DR
Practice Address - Street 2:DEPARTMENT OF PHARMACY
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2639
Practice Address - Country:US
Practice Address - Phone:614-722-2199
Practice Address - Fax:614-722-2189
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0124131835P0200X
OH03-02-264881835P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0200XPharmacy Service ProvidersPharmacistPediatrics