=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457812729
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IVIA HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2019
-----------------------------------------------------
Last Update Date | 03/28/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 828 N OLDEN AVE STE 3
-----------------------------------------------------
City | TRENTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08638-4902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-989-0134
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 828 N OLDEN AVE STE 3
-----------------------------------------------------
City | TRENTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08638-4902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-989-0134
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | OMER UGUR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 267-777-2654
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0004X
-----------------------------------------------------
Taxonomy Name | Compounding Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------