Provider Demographics
NPI:1093231474
Name:CREATIVE PHARMACY SOLUTIONS CENTRAL, LLC
Entity Type:Organization
Organization Name:CREATIVE PHARMACY SOLUTIONS CENTRAL, LLC
Other - Org Name:PHARMACY INNOVATIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MOON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:716-720-5121
Mailing Address - Street 1:2535 JOHNS PL
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-9210
Mailing Address - Country:US
Mailing Address - Phone:716-720-5121
Mailing Address - Fax:716-708-6248
Practice Address - Street 1:780 PRIMOS AVE STE E
Practice Address - Street 2:
Practice Address - City:FOLCROFT
Practice Address - State:PA
Practice Address - Zip Code:19032-2000
Practice Address - Country:US
Practice Address - Phone:610-522-9006
Practice Address - Fax:610-522-9088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-17
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP482153333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy