Provider Demographics
NPI:1235783945
Name:INNOVATIVE RX, P.C.
Entity Type:Organization
Organization Name:INNOVATIVE RX, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DALY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, RP
Authorized Official - Phone:308-708-5070
Mailing Address - Street 1:416 W 48TH ST STE 20
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-1315
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:416 W 48TH ST STE 20
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-1315
Practice Address - Country:US
Practice Address - Phone:308-430-3668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-31
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE754OtherPHARMACY LICENSE NUMBER