Provider Demographics
NPI:1467495234
Name:INNOVATIVE PHARMACY SERVICES INC
Entity Type:Organization
Organization Name:INNOVATIVE PHARMACY SERVICES INC
Other - Org Name:GUY'S INNOVATIVE PHARMACY VITAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:GUY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:601-684-4127
Mailing Address - Street 1:312B MARION AVE
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-2708
Mailing Address - Country:US
Mailing Address - Phone:601-684-4127
Mailing Address - Fax:601-684-8479
Practice Address - Street 1:312B MARION AVE
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-2708
Practice Address - Country:US
Practice Address - Phone:601-684-4127
Practice Address - Fax:601-684-8479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS03331/02.0332B00000X, 333600000X, 3336H0001X, 3336S0011X
MS0331/02.0332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07879769Medicaid
MS00579729Medicaid
MS000030276OtherBCBS OF MS
MS04784248Medicaid
MS07879769Medicaid