NPIMap

Organization Active NPI

Innominds LLC

Doing business as East Valley Pharmacy

  • Community/Retail Pharmacy
  • Union Gap, WA
National Provider Identifier
1508675364
Registry record updated Jan 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
INNOMINDS LLC
Doing business as
East Valley Pharmacy
Practice address
1215 E Washington Ave
Union Gap, WA 98903-1669
Phone
(509) 823-1657
Fax
(509) 823-1658
NPI assigned
Jan 6, 2025
Last updated
Jan 6, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Mastan Ramprasad Gangisetti, RPH
Title
Pharmacy Manager
Phone
(509) 942-4835

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

1215 E Washington Ave
Union Gap, WA 98903-1669

Mailing address

PO Box 8201
Yakima, WA 98908-0201
Phone (509) 823-1657

Other names 1

  • East Valley Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20250505002877 WA Part B Supplier - Mass Immunization (Roster Biller Only) 4880111723 1 other NPI on this enrollment
Practice locations: Union Gap, WA; Yakima, WA
O20250620001526 WA DME Supplier - Pharmacy 4880111723 Practice locations: Union Gap, 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 LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1736121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736121600000",
    "number": "1508675364",
    "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": "509-823-1657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 E WASHINGTON AVE",
            "city": "UNION GAP",
            "state": "WA",
            "postal_code": "989031669",
            "telephone_number": "509-823-1657",
            "fax_number": "509-823-1658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOMINDS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-06",
        "last_updated": "2025-01-06",
        "certification_date": "2024-12-27",
        "status": "A",
        "authorized_official_last_name": "GANGISETTI",
        "authorized_official_first_name": "MASTAN RAMPRASAD",
        "authorized_official_title_or_position": "PHARMACY MANAGER",
        "authorized_official_telephone_number": "509-942-4835",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Valley Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Union Gap, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 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.

Verify at the official NPI Registry.