Active NPI
Innominds LLC
- Community/Retail Pharmacy
- Yakima, WA
National Provider Identifier
1104719160
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- Legal business name
- INNOMINDS LLC
- Practice address
- 1103 S 72ND Ave Ste 100
Yakima, WA 98908-1913 - Phone
- (509) 823-1653
- Fax
- (509) 823-1654
- NPI assigned
- May 29, 2025
- Organization subpart
- Yes
- Parent organization
- INNOMINDS LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Srini Mandava, RPH
- Title
- Pharmacy Manager
- Phone
- (509) 899-6021
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | Primary | ||
| Compounding Pharmacy | 3336C0004X |
Addresses
Primary practice location
1103 S 72ND Ave Ste 100
Yakima, WA 98908-1913
Mailing address
PO Box 8201
Yakima, WA 98908-0201
Phone (509) 823-1653
Other names 1
- West Valley Pharmacy
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250505002877 | WA | Part B Supplier - Mass Immunization (Roster Biller Only) | 4880111723 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Union Gap, WA; Yakima, WA |
| O20251211003808 | WA | DME Supplier - Pharmacy | 4880111723 | Practice locations: Yakima, WA |
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider Directory- Tax ID family
- Innominds LLC
- Part of
- Innominds LLC
Other organizations with this tax ID 3
Organizations that report the same tax identification number in the National Provider Directory.
-
- Long Term Care Pharmacy
- Union Gap, WA
- NPI 1154244101
-
- Community/Retail Pharmacy
- Union Gap, WA
- NPI 1508675364
-
- Long Term Care Pharmacy
- Yakima, WA
- NPI 1790631778
Member organizations 1
Organizations listed as members of this organization in the National Provider Directory.
Locations
1103 S 72nd Ave
Yakima, WA 98908
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1748476800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1750809600000",
"number": "1104719160",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 8201",
"city": "YAKIMA",
"state": "WA",
"postal_code": "989080201",
"telephone_number": "509-823-1653",
"fax_number": "509-823-1654"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1103 S 72ND AVE STE 100",
"city": "YAKIMA",
"state": "WA",
"postal_code": "989081913",
"telephone_number": "509-823-1653",
"fax_number": "509-823-1654"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "INNOMINDS LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "INNOMINDS LLC",
"enumeration_date": "2025-05-29",
"last_updated": "2025-06-25",
"certification_date": "2025-06-25",
"status": "A",
"authorized_official_last_name": "MANDAVA",
"authorized_official_first_name": "SRINI",
"authorized_official_title_or_position": "PHARMACY MANAGER",
"authorized_official_telephone_number": "509-899-6021",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "RPH"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": null,
"license": null,
"primary": true
},
{
"code": "3336C0004X",
"taxonomy_group": "",
"desc": "Pharmacy, Compounding Pharmacy",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "West Valley Pharmacy",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Yakima, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.