Provider Demographics
NPI:1952933038
Name:NOVA HEALTH LLC
Entity Type:Organization
Organization Name:NOVA HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:NEVEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NOFAL
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTEREDPHARMACIST
Authorized Official - Phone:865-765-1771
Mailing Address - Street 1:1408 SUMMIT AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-8135
Mailing Address - Country:US
Mailing Address - Phone:972-729-9009
Mailing Address - Fax:469-661-3905
Practice Address - Street 1:1408 SUMMIT AVE STE 2
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-8135
Practice Address - Country:US
Practice Address - Phone:972-726-9009
Practice Address - Fax:469-661-3905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-06
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150194Medicaid