Provider Demographics
NPI:1821584350
Name:POA PHARMA NORTH AMERICA LLC
Entity Type:Organization
Organization Name:POA PHARMA NORTH AMERICA LLC
Other - Org Name:NOVAM-NUTRITION LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MADSEN SANDSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-416-6826
Mailing Address - Street 1:4400 NE 77TH AVE STE 275
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6857
Mailing Address - Country:US
Mailing Address - Phone:855-416-6826
Mailing Address - Fax:360-326-1621
Practice Address - Street 1:4400 NE 77TH AVE
Practice Address - Street 2:SUITE 275
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6857
Practice Address - Country:US
Practice Address - Phone:855-416-6826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies