Provider Demographics
NPI:1225199359
Name:PHARMA NOVA, INC.
Entity Type:Organization
Organization Name:PHARMA NOVA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTEGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-224-6027
Mailing Address - Street 1:3520 SAN YSIDRO WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-2816
Mailing Address - Country:US
Mailing Address - Phone:916-224-6027
Mailing Address - Fax:
Practice Address - Street 1:3520 SAN YSIDRO WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95864-2816
Practice Address - Country:US
Practice Address - Phone:916-224-6027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58917183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty