# NOVAM-NUTRITION LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376952275
- **Authorized official:** MR. DAVID LINDSLEY (PRESIDENT)
- **Authorized official phone:** (855) 416-6826

## Contact information

- **Practice address:** 15455 NW GREENBRIER PKWY, SUITE \#100, BEAVERTON, OR 97006-7374
- **Practice address phone:** (855) 416-6826
- **Practice address fax:** (360) 326-1621
- **Mailing address:** 15455 NW GREENBRIER PKWY, SUITE \#100, BEAVERTON, OR 97006-7374
- **Mailing address phone:** (855) 416-6826
- **Mailing address fax:** (360) 326-1621

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | — | NULL | — |
| 335G00000X | Medical Foods Supplier | — | NULL | Yes |

## Other

- **Enumeration date:** 08/05/2014
- **Last updated:** 08/05/2014