Provider Demographics
NPI:1548260540
Name:NOVAK, ALLEN C (RPH, FASCP)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:C
Last Name:NOVAK
Suffix:
Gender:M
Credentials:RPH, FASCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 TAMARACK AVE
Mailing Address - Street 2:APT H
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-4067
Mailing Address - Country:US
Mailing Address - Phone:760-445-2224
Mailing Address - Fax:
Practice Address - Street 1:355 TAMARACK AVE
Practice Address - Street 2:APT H
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-4067
Practice Address - Country:US
Practice Address - Phone:760-445-2224
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA515771835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy