Provider Demographics
NPI:1336258565
Name:INSTITUTIONAL PHARMACY SOLUTIONS, LLC
Entity Type:Organization
Organization Name:INSTITUTIONAL PHARMACY SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MIMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-356-7627
Mailing Address - Street 1:400 INTERSTATE PARK DR
Mailing Address - Street 2:SUITE 422
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36109-5428
Mailing Address - Country:US
Mailing Address - Phone:334-356-7627
Mailing Address - Fax:334-356-7647
Practice Address - Street 1:700 E COTTONWOOD RD
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3644
Practice Address - Country:US
Practice Address - Phone:334-794-7373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1801523336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100010020Medicaid