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General NPI Number Information
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NPI Number | 1538032610
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Entity Type | Organization
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Legal Business Name | NUTRITION PATHWAYS LLC
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Dates
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Enumeration Date | 09/25/2025
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Last Update Date | 09/25/2025
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Provider Practice Location Address
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Address Line | 170 AIRPARK BLVD # 103
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City | IMMOKALEE
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State | FL
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Zip | 34142-3833
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Country | US
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Telephone | 239-217-4888
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Fax |
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Provider Business Mailing Address
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Address Line | 750 S 5TH ST STE 100D
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City | IMMOKALEE
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State | FL
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Zip | 34142-4301
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | PAUL THEIN
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Credential |
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Telephone | 239-302-9223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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