Healthcare Provider Details

I. General information

NPI: 1487355566
Provider Name (Legal Business Name): NOVEL RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 E 4TH ST
NEW YORK NY
10009-8501
US

IV. Provider business mailing address

360 E 4TH ST
NEW YORK NY
10009-8501
US

V. Phone/Fax

Practice location:
  • Phone: 212-677-7335
  • Fax: 212-677-7244
Mailing address:
  • Phone: 212-677-7335
  • Fax: 212-677-7244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MRS. MANJULA NALAJALLA
Title or Position: MEMBER
Credential:
Phone: 251-408-7261