Provider Demographics
NPI:1376952275
Name:NOVAM-NUTRITION LLC
Entity Type:Organization
Organization Name:NOVAM-NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-416-6826
Mailing Address - Street 1:15455 NW GREENBRIER PKWY
Mailing Address - Street 2:SUITE #100
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-7374
Mailing Address - Country:US
Mailing Address - Phone:855-416-6826
Mailing Address - Fax:360-326-1621
Practice Address - Street 1:15455 NW GREENBRIER PKWY
Practice Address - Street 2:SUITE #100
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-7374
Practice Address - Country:US
Practice Address - Phone:855-416-6826
Practice Address - Fax:360-326-1621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335G00000XSuppliersMedical Foods Supplier
No332900000XSuppliersNon-Pharmacy Dispensing Site