Provider Demographics
NPI:1003845868
Name:NOVA 1 CORP
Entity Type:Organization
Organization Name:NOVA 1 CORP
Other - Org Name:GROVE PHARMACY & AA MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:G
Authorized Official - Last Name:WEISBEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-662-4477
Mailing Address - Street 1:1234 S DIXIE HWY
Mailing Address - Street 2:SUITE 324
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2902
Mailing Address - Country:US
Mailing Address - Phone:305-662-4477
Mailing Address - Fax:
Practice Address - Street 1:3692 GRAND AVE
Practice Address - Street 2:STE B
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4953
Practice Address - Country:US
Practice Address - Phone:305-662-4477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
FLPH256303336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0836540001Medicare NSC