Provider Demographics
NPI:1104719160
Name:INNOMINDS LLC
Entity type:Organization
Organization Name:INNOMINDS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SRINI
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDAVA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:509-899-6021
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:509-823-1653
Mailing Address - Fax:509-823-1654
Practice Address - Street 1:1103 S 72ND AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-1913
Practice Address - Country:US
Practice Address - Phone:509-823-1653
Practice Address - Fax:509-823-1654
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INNOMINDS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy