Provider Demographics
NPI:1265293500
Name:PHARMACY INNOVATIONS LLC
Entity type:Organization
Organization Name:PHARMACY INNOVATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GAVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DULEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:620-725-3262
Mailing Address - Street 1:165 KAISER WAY
Mailing Address - Street 2:
Mailing Address - City:DEWEY
Mailing Address - State:OK
Mailing Address - Zip Code:74029-3029
Mailing Address - Country:US
Mailing Address - Phone:620-674-1596
Mailing Address - Fax:
Practice Address - Street 1:616 CEDAR ST
Practice Address - Street 2:
Practice Address - City:CEDAR VALE
Practice Address - State:KS
Practice Address - Zip Code:67024-9704
Practice Address - Country:US
Practice Address - Phone:620-758-2711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHARMACY INNOVATIONS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy