Provider Demographics
NPI:1457084253
Name:IVATION PHARMACY LLC
Entity Type:Organization
Organization Name:IVATION PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP, CLOUD AND SPECIALTY PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NAMETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-266-5515
Mailing Address - Street 1:305 N HEATHERWILDE BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-4192
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:305 N HEATHERWILDE BLVD STE 220
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-4192
Practice Address - Country:US
Practice Address - Phone:512-549-8519
Practice Address - Fax:866-676-5890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX34351OtherBOARD OF PHARMACY