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General NPI Number Information
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NPI Number | 1598903130
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Entity Type | Organization
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Legal Business Name | PHARMA NOVA INC
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Dates
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Enumeration Date | 02/04/2009
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Last Update Date | 01/13/2010
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Provider Practice Location Address
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Address Line | 4404 DEL RIO RD
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City | SACRAMENTO
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State | CA
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Zip | 95822-1126
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Country | US
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Telephone | 916-452-2200
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Fax | 916-452-2247
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Provider Business Mailing Address
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Address Line | 4404 DEL RIO RD
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City | SACRAMENTO
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State | CA
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Zip | 95822-1126
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Country | US
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Telephone | 916-452-2200
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Fax | 916-452-2247
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Authorized Official
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Title or Position | PRESIDENT/PHARMACIST IN CHARGE
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Name | JOHN ORTEGO
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Credential |
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Telephone | 916-224-6027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding 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 | 49289
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License Number State | CA
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