Healthcare Provider Details

I. General information

NPI: 1598903130
Provider Name (Legal Business Name): PHARMA NOVA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2009
Last Update Date: 01/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4404 DEL RIO RD
SACRAMENTO CA
95822-1126
US

IV. Provider business mailing address

4404 DEL RIO RD
SACRAMENTO CA
95822-1126
US

V. Phone/Fax

Practice location:
  • Phone: 916-452-2200
  • Fax: 916-452-2247
Mailing address:
  • Phone: 916-452-2200
  • Fax: 916-452-2247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number49289
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOHN ORTEGO
Title or Position: PRESIDENT/PHARMACIST IN CHARGE
Credential:
Phone: 916-224-6027