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General NPI Number Information
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NPI Number | 1588258859
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Entity Type | Organization
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Legal Business Name | 9NINE ONLINE STORE LLC
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Dates
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Enumeration Date | 02/26/2021
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Last Update Date | 02/26/2021
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Provider Practice Location Address
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Address Line | 3325 LONGVIEW DR
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City | SACRAMENTO
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State | CA
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Zip | 95821-7103
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Country | US
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Telephone | 916-299-9942
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Fax | 916-299-9941
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Provider Business Mailing Address
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Address Line | PO BOX 661414
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City | SACRAMENTO
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State | CA
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Zip | 95866-1414
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Country | US
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Telephone | 916-299-9942
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Fax | 916-299-9941
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Authorized Official
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Title or Position | CEO
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Name | SYED RAZA
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Credential |
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Telephone | 916-299-9942
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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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 | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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