Provider Demographics
NPI:1043988066
Name:INNOVATION PHARMACY INC
Entity Type:Organization
Organization Name:INNOVATION PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:OSAMAH
Authorized Official - Middle Name:
Authorized Official - Last Name:AWAD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:518-783-1210
Mailing Address - Street 1:1097 LOUDEN
Mailing Address - Street 2:
Mailing Address - City:COHOES
Mailing Address - State:NY
Mailing Address - Zip Code:12047-4903
Mailing Address - Country:US
Mailing Address - Phone:187-831-2105
Mailing Address - Fax:
Practice Address - Street 1:1097 LOUDEN
Practice Address - Street 2:
Practice Address - City:COHOES
Practice Address - State:NY
Practice Address - Zip Code:12047-4903
Practice Address - Country:US
Practice Address - Phone:518-783-1210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy