Provider Demographics
NPI:1477054567
Name:INNOVA RX INC.
Entity Type:Organization
Organization Name:INNOVA RX INC.
Other - Org Name:CEDARMAK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIAMAK
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGHERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-303-7860
Mailing Address - Street 1:8737 BEVERLY BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90048-1835
Mailing Address - Country:US
Mailing Address - Phone:424-303-7860
Mailing Address - Fax:424-303-7854
Practice Address - Street 1:8737 BEVERLY BLVD STE 102
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1835
Practice Address - Country:US
Practice Address - Phone:424-303-7860
Practice Address - Fax:424-303-7854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA560743336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy