1346798824 NPI number — HEALTH INNOVATIONS OF SANFORD, INC.

Table of content: (NPI 1346798824)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346798824 NPI number — HEALTH INNOVATIONS OF SANFORD, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH INNOVATIONS OF SANFORD, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HEALTH INNOVATIONS PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346798824
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
814 SPRING LANE DR.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANFORD
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27330-3437
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-777-0402
Provider Business Mailing Address Fax Number:
919-777-0217

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
295 PINEHURST AVE.
Provider Second Line Business Practice Location Address:
BLDG. 2
Provider Business Practice Location Address City Name:
SOUTHERN PINES
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28387-7052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-246-5155
Provider Business Practice Location Address Fax Number:
910-246-2324
Provider Enumeration Date:
09/14/2016

Additional Information

Authorized Official

Authorized Official Last Name:
CLARK
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
HALL
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
910-246-5155

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  11195 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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