Provider Demographics
NPI:1851567812
Name:INNOVATIVE SERVICES INC
Entity type:Organization
Organization Name:INNOVATIVE SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:KRAMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-515-6719
Mailing Address - Street 1:PO BOX 325
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NY
Mailing Address - Zip Code:13323-0325
Mailing Address - Country:US
Mailing Address - Phone:131-585-3128
Mailing Address - Fax:315-853-6087
Practice Address - Street 1:200 AIRPARK DR
Practice Address - Street 2:SUITE 90
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-5716
Practice Address - Country:US
Practice Address - Phone:585-328-2050
Practice Address - Fax:585-328-2058
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UPSTATE NEWCO LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-30
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3358771OtherNCPDP
NY028984OtherPHARMACY LICENSE
NY0701L003OtherDOH LICENSE NUMBER
NY0701L003OtherDOH LICENSE NUMBER