Provider Demographics
NPI:1124767116
Name:INNOVATIVE PHARMACY SERVICES, LLC
Entity type:Organization
Organization Name:INNOVATIVE PHARMACY SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MULDERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-588-1000
Mailing Address - Street 1:3033 W PRESIDENT GEORGE BUSH HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-5752
Mailing Address - Country:US
Mailing Address - Phone:972-588-1000
Mailing Address - Fax:
Practice Address - Street 1:7381 114TH AVE STE 402
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-5131
Practice Address - Country:US
Practice Address - Phone:727-268-8982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INNOVATIVE PHARMACY SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-31
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No251F00000XAgenciesHome Infusion
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition