Healthcare Provider Details

I. General information

NPI: 1003513110
Provider Name (Legal Business Name): INNOVA PHARMACY OF ARDEN-ARCADE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2023
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5830 JAMESON CT
CARMICHAEL CA
95608-0896
US

IV. Provider business mailing address

5830 JAMESON CT
CARMICHAEL CA
95608-0896
US

V. Phone/Fax

Practice location:
  • Phone: 916-623-4444
  • Fax: 916-623-4440
Mailing address:
  • Phone: 916-623-4444
  • Fax: 916-623-4440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. TIM THIEN LE
Title or Position: CEO
Credential: PHARM.D.
Phone: 916-220-3344