Provider Demographics
NPI:1205288479
Name:HEALTH INNOVATIONS PHARMACY, INC.
Entity type:Organization
Organization Name:HEALTH INNOVATIONS PHARMACY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:910-246-5155
Mailing Address - Street 1:295 PINEHURST AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-7023
Mailing Address - Country:US
Mailing Address - Phone:910-246-5155
Mailing Address - Fax:910-246-2324
Practice Address - Street 1:295 PINEHURST AVE
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-7023
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
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1073651063OtherIMMUNIZATION
NC1073651063Medicare NSC