Provider Demographics
NPI:1700856846
Name:NOVA INFUSION & COMPOUNDING PHARMACY CORP
Entity Type:Organization
Organization Name:NOVA INFUSION & COMPOUNDING PHARMACY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, COO
Authorized Official - Prefix:MR
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGARRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-779-6682
Mailing Address - Street 1:PO BOX 3698
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-3698
Mailing Address - Country:US
Mailing Address - Phone:787-779-6682
Mailing Address - Fax:787-779-6688
Practice Address - Street 1:CARR. 199 INT . CARR. 838 CAMINO ALEJANDRINO
Practice Address - Street 2:LAS CUMBRES OFFICE BUILDING SE
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00970-3968
Practice Address - Country:US
Practice Address - Phone:787-779-6682
Practice Address - Fax:787-779-6688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
08-F-2376251F00000X
PR08-F-2376261QI0500X
PR333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4224780001Medicare NSC