Innova Pharmacy III

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

INNOVA PHARMACY III

Practice address

2400 Glendale LN Ste a
Sacramento, CA 95825-2431

Phone

(916) 487-9977

Fax

(916) 487-9978

NPI assigned

Jan 14, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Tim Thien Le, PHARM.D.

Title

President/Ceo

Phone

(916) 220-3344

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1578960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593993600000",
    "number": "1740820133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1913 EAGLE GLEN DR",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956614025",
            "telephone_number": "916-220-3344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 GLENDALE LN STE A",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958252431",
            "telephone_number": "916-487-9977",
            "fax_number": "916-487-9978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVA PHARMACY III",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-14",
        "last_updated": "2020-07-06",
        "certification_date": "2020-07-06",
        "status": "A",
        "authorized_official_last_name": "LE",
        "authorized_official_first_name": "TIM",
        "authorized_official_middle_name": "THIEN",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "916-220-3344",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARM.D."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1740820133",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Innova Pharmacy II
• Innova Pharmacy of Arden-Arcade
• Innovage California Pace-Sacramento, LLC
• Innovative DME LLC
• Isao K. Inouye, MD
• Maya Inozemtseva, PT, DPT, ATC

• Community/Retail Pharmacy in Sacramento, CA
• Providers in Sacramento, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.