Provider Demographics
NPI:1346798824
Name:HEALTH INNOVATIONS OF SANFORD, INC.
Entity Type:Organization
Organization Name:HEALTH INNOVATIONS OF SANFORD, INC.
Other - Org Name:HEALTH INNOVATIONS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:HALL
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:910-246-5155
Mailing Address - Street 1:814 SPRING LANE DR.
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-3437
Mailing Address - Country:US
Mailing Address - Phone:919-777-0402
Mailing Address - Fax:919-777-0217
Practice Address - Street 1:295 PINEHURST AVE.
Practice Address - Street 2:BLDG. 2
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-7052
Practice Address - Country:US
Practice Address - Phone:910-246-5155
Practice Address - Fax:910-246-2324
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH INNOVATIONS PHARMACY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC111953336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy