# 9NINE ONLINE STORE LLC

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

## Provider details

- **NPI number:** 1588258859
- **Authorized official:** SYED RAZA (CEO)
- **Authorized official phone:** (916) 299-9942

## Contact information

- **Practice address:** 3325 LONGVIEW DR, SACRAMENTO, CA 95821-7103
- **Practice address phone:** (916) 299-9942
- **Practice address fax:** (916) 299-9941
- **Mailing address:** PO BOX 661414, SACRAMENTO, CA 95866-1414
- **Mailing address phone:** (916) 299-9942
- **Mailing address fax:** (916) 299-9941

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | Yes |
| 332BP3500X | Parenteral & Enteral Nutrition Supplies (DME) | — | NULL | — |

## Other

- **Enumeration date:** 02/26/2021
- **Last updated:** 02/26/2021