Provider Demographics
NPI:1346323946
Name:INNOVATIVE PHARMACISTS INC
Entity Type:Organization
Organization Name:INNOVATIVE PHARMACISTS INC
Other - Org Name:L T PEDLEY DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:L
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, RP
Authorized Official - Phone:308-832-2816
Mailing Address - Street 1:PO BOX 108
Mailing Address - Street 2:419 N COLORADO AVE
Mailing Address - City:MINDEN
Mailing Address - State:NE
Mailing Address - Zip Code:68959-0108
Mailing Address - Country:US
Mailing Address - Phone:308-832-2816
Mailing Address - Fax:308-832-2047
Practice Address - Street 1:419 N COLORADO AVE
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:NE
Practice Address - Zip Code:68959-1654
Practice Address - Country:US
Practice Address - Phone:308-832-2816
Practice Address - Fax:308-832-2047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE23943336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE2803422OtherNCPDP
NE=========00Medicaid
NE2803422OtherNCPDP