Provider Demographics
NPI:1972968204
Name:INTEGRATIVE PHARMACY SOLUTIONS, INC
Entity Type:Organization
Organization Name:INTEGRATIVE PHARMACY SOLUTIONS, INC
Other - Org Name:KING'S PHARMACY AND COMPOUNDING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, PIC, AO
Authorized Official - Prefix:
Authorized Official - First Name:RANI
Authorized Official - Middle Name:
Authorized Official - Last Name:DIBBINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-970-4987
Mailing Address - Street 1:16205 SAND CANYON AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3781
Mailing Address - Country:US
Mailing Address - Phone:949-387-0780
Mailing Address - Fax:949-387-0784
Practice Address - Street 1:16205 SAND CANYON AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3781
Practice Address - Country:US
Practice Address - Phone:949-387-0780
Practice Address - Fax:949-387-0784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-31
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
CA538353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2158251OtherPK