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General NPI Number Information
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NPI Number | 1366846370
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Entity Type | Organization
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Legal Business Name | NOVA PHARMACY LP
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Dates
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Enumeration Date | 10/20/2014
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Last Update Date | 03/29/2016
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Provider Practice Location Address
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Address Line | 8833 GROSS POINT RD STE 311
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City | SKOKIE
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State | IL
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Zip | 60077-1859
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Country | US
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Telephone | 224-534-0203
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Fax | 224-534-0204
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Provider Business Mailing Address
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Address Line | 8833 GROSS POINT RD STE 311
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City | SKOKIE
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State | IL
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Zip | 60077-1859
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Country | US
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Telephone | 224-534-0203
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Fax | 224-534-0204
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | FEDJA TEMIM
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Credential |
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Telephone | 224-534-0203
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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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 | 054.018834
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License Number State | IL
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