Healthcare Provider Details

I. General information

NPI: 1700856846
Provider Name (Legal Business Name): NOVA INFUSION & COMPOUNDING PHARMACY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 199 INT . CARR. 838 CAMINO ALEJANDRINO LAS CUMBRES OFFICE BUILDING SE
GUAYNABO PR
00970-3968
US

IV. Provider business mailing address

PO BOX 3698
GUAYNABO PR
00970-3698
US

V. Phone/Fax

Practice location:
  • Phone: 787-779-6682
  • Fax: 787-779-6688
Mailing address:
  • Phone: 787-779-6682
  • Fax: 787-779-6688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number08-F-2376
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number08-F-2376
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StatePR

VIII. Authorized Official

Name: MR. MILTON SEGARRA
Title or Position: PRESIDENT, COO
Credential:
Phone: 787-779-6682