Provider Demographics
NPI:1871041921
Name:INVENTRX COMPOUNDING SOLUTIONS, INC.
Entity Type:Organization
Organization Name:INVENTRX COMPOUNDING SOLUTIONS, INC.
Other - Org Name:DAVISHEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DWAIN
Authorized Official - Middle Name:DAVIS
Authorized Official - Last Name:WILKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:757-745-7440
Mailing Address - Street 1:2100 EXECUTIVE DR
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-2402
Mailing Address - Country:US
Mailing Address - Phone:757-745-7440
Mailing Address - Fax:
Practice Address - Street 1:2100 EXECUTIVE DR
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2402
Practice Address - Country:US
Practice Address - Phone:757-745-7440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-19
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA261QP2300X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care