Provider Demographics
NPI:1134678774
Name:HEALTH INNOVATIONS OF LAURINBURG, INC.
Entity Type:Organization
Organization Name:HEALTH INNOVATIONS OF LAURINBURG, INC.
Other - Org Name:HEALTH INNOVATIONS PHARMACY OF LAURINBURG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:HALL
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:910-361-4731
Mailing Address - Street 1:901 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28352-4736
Mailing Address - Country:US
Mailing Address - Phone:910-361-4731
Mailing Address - Fax:
Practice Address - Street 1:901 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-4736
Practice Address - Country:US
Practice Address - Phone:910-361-4731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC110693336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy