Provider Demographics
NPI:1821330150
Name:INNOVATIVERX GULF COAST PHARMACY INC
Entity Type:Organization
Organization Name:INNOVATIVERX GULF COAST PHARMACY INC
Other - Org Name:INNOVATIVERX GULF COAST PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAZDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-324-9619
Mailing Address - Street 1:1035 COLLIER CENTER WAY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-8474
Mailing Address - Country:US
Mailing Address - Phone:239-324-9619
Mailing Address - Fax:
Practice Address - Street 1:1035 COLLIER CENTER WAY STE 2
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-8474
Practice Address - Country:US
Practice Address - Phone:239-324-9619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH264913336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5713892OtherNCPDP PROVIDER IDENTIFICATION NUMBER