Provider Demographics
NPI:1508675364
Name:INNOMINDS LLC
Entity type:Organization
Organization Name:INNOMINDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MASTAN RAMPRASAD
Authorized Official - Middle Name:
Authorized Official - Last Name:GANGISETTI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:509-942-4835
Mailing Address - Street 1:PO BOX 8201
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-0201
Mailing Address - Country:US
Mailing Address - Phone:509-823-1657
Mailing Address - Fax:
Practice Address - Street 1:1215 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:UNION GAP
Practice Address - State:WA
Practice Address - Zip Code:98903-1669
Practice Address - Country:US
Practice Address - Phone:509-823-1657
Practice Address - Fax:509-823-1658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy