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General NPI Number Information
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NPI Number | 1376952275
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Entity Type | Organization
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Legal Business Name | NOVAM-NUTRITION LLC
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Dates
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Enumeration Date | 08/05/2014
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Last Update Date | 08/05/2014
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Provider Practice Location Address
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Address Line | 15455 NW GREENBRIER PKWY SUITE #100
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City | BEAVERTON
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State | OR
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Zip | 97006-7374
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Country | US
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Telephone | 855-416-6826
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Fax | 360-326-1621
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Provider Business Mailing Address
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Address Line | 15455 NW GREENBRIER PKWY SUITE #100
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City | BEAVERTON
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State | OR
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Zip | 97006-7374
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Country | US
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Telephone | 855-416-6826
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Fax | 360-326-1621
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DAVID LINDSLEY
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Credential |
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Telephone | 855-416-6826
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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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 | 335G00000X
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Taxonomy Name | Medical Foods Supplier
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License Number |
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License Number State |
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