Provider Demographics
NPI:1710679766
Name:INNOVATION PHARMACY INC.
Entity Type:Organization
Organization Name:INNOVATION PHARMACY INC.
Other - Org Name:INNOVATION RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:949-340-1700
Mailing Address - Street 1:18102 IRVINE BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3423
Mailing Address - Country:US
Mailing Address - Phone:949-340-1700
Mailing Address - Fax:949-340-1699
Practice Address - Street 1:18102 IRVINE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3423
Practice Address - Country:US
Practice Address - Phone:949-340-1700
Practice Address - Fax:949-340-1699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-25
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy