Provider Demographics
NPI:1225568058
Name:INNOVIA RX LLC
Entity Type:Organization
Organization Name:INNOVIA RX LLC
Other - Org Name:HEALTH RX SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NILIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:214-843-4727
Mailing Address - Street 1:624 TERRACE ST
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-2021
Mailing Address - Country:US
Mailing Address - Phone:214-843-4727
Mailing Address - Fax:
Practice Address - Street 1:580 S DENTON TAP RD STE 295
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4098
Practice Address - Country:US
Practice Address - Phone:469-830-7400
Practice Address - Fax:469-830-7401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-14
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150366Medicaid
TX33569OtherSTATE PHARMACY LICENSE