MEDICARE: NOVA PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy		PR

General Provider Information

NPI Number	:	1598990228
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVA PHARMACY

Provider Business Mailing Address
First Line	:	PO BOX 1050
Second Line	:
City	:	SALINAS
State	:	PR
Zip	:	00751-1050
Country	:	US
Telephone Number	:	787-845-2400
Fax Number	:

Provider Business Practice Location Address
First Line	:	18 CALLE BETANCES
Second Line	:
City	:	SANTA ISABEL
State	:	PR
Zip	:	00757-2632
Country	:	US
Telephone Number	:	787-845-2400
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GERARDO RIVERA
Credential	:
Telephone Number	:	787-845-2400

Provider Enumeration Date	:	05/26/2009
Last Update Date	:	05/26/2009

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Directions to “NOVA PHARMACY ” Practice Location

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