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General NPI Number Information
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NPI Number | 1225199359
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Entity Type | Organization
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Legal Business Name | PHARMA NOVA, INC.
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 01/16/2008
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Provider Practice Location Address
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Address Line | 3520 SAN YSIDRO WAY
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City | SACRAMENTO
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State | CA
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Zip | 95864-2816
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Country | US
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Telephone | 916-224-6027
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Fax |
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Provider Business Mailing Address
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Address Line | 3520 SAN YSIDRO WAY
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City | SACRAMENTO
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State | CA
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Zip | 95864-2816
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Country | US
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Telephone | 916-224-6027
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Fax |
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Authorized Official
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Title or Position | PRESIDENT, PHARMACIST IN CHARGE
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Name | DR. JOHN ORTEGO
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Credential |
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Telephone | 916-224-6027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 58917
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License Number State | CA
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