Provider Demographics
NPI:1790132280
Name:INNOVATIVE PHARMACEUTICAL SOLUTIONS GROUP
Entity Type:Organization
Organization Name:INNOVATIVE PHARMACEUTICAL SOLUTIONS GROUP
Other - Org Name:INNOVATIVE PHARMACEUTICAL SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-980-9875
Mailing Address - Street 1:2250 GENOA BUSINESS PARK DR
Mailing Address - Street 2:SUITE 120-A
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-7371
Mailing Address - Country:US
Mailing Address - Phone:517-980-9875
Mailing Address - Fax:
Practice Address - Street 1:2250 GENOA BUSINESS PARK DR STE 120A
Practice Address - Street 2:SUITE 120-A
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-7372
Practice Address - Country:US
Practice Address - Phone:517-980-9875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-16
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BN1400X, 333600000X, 3336C0004X, 3336M0002X, 3336S0011X
MI53010109353336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159997OtherPK