Individual
STACEY L NOVOTNY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPHT
Contact information
Practice address
2005 W. BROADWAY, PRINCETON, IN 47670
(812) 386-7672
(812) 386-5155
Mailing address
9810 S. JOY LANE, HAUBSTADT, IN 47639
(812) 768-5248
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
6700258A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6700258A
STATE LICENSE
IN
Enumeration date
05/11/2007
Last updated
07/08/2007
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