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General NPI Number Information
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NPI Number | 1003845868
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Entity Type | Organization
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Legal Business Name | NOVA 1 CORP
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Dates
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Enumeration Date | 07/02/2006
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Last Update Date | 01/29/2013
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Provider Practice Location Address
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Address Line | 3692 GRAND AVE STE B
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City | MIAMI
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State | FL
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Zip | 33133-4953
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Country | US
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Telephone | 305-662-4477
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Fax |
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Provider Business Mailing Address
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Address Line | 1234 S DIXIE HWY SUITE 324
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City | CORAL GABLES
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State | FL
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Zip | 33146-2902
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Country | US
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Telephone | 305-662-4477
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RAYMOND G WEISBEIN
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Credential |
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Telephone | 305-662-4477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH25630
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License Number State | FL
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