Provider Demographics
NPI:1184382863
Name:INNOVAHEALTH, LLC
Entity type:Organization
Organization Name:INNOVAHEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ZILNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-349-1111
Mailing Address - Street 1:645 KOLTER DR
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3522
Mailing Address - Country:US
Mailing Address - Phone:724-349-1111
Mailing Address - Fax:724-349-2984
Practice Address - Street 1:641 KOLTER DR
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3570
Practice Address - Country:US
Practice Address - Phone:724-992-5105
Practice Address - Fax:877-224-0345
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAPPHIREHEALTH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy