Provider Demographics
NPI:1831937101
Name:INNOVATIVE MEDS RX
Entity type:Organization
Organization Name:INNOVATIVE MEDS RX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:LUCAS
Authorized Official - Last Name:EDLEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:850-776-3804
Mailing Address - Street 1:364 N SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-3532
Mailing Address - Country:US
Mailing Address - Phone:336-789-5050
Mailing Address - Fax:336-786-7169
Practice Address - Street 1:364 N SOUTH ST
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-3532
Practice Address - Country:US
Practice Address - Phone:336-789-5050
Practice Address - Fax:336-786-7169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy