Provider Demographics
NPI:1912266172
Name:IONIA PHARMACY, LLC
Entity Type:Organization
Organization Name:IONIA PHARMACY, LLC
Other - Org Name:IONIA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-319-8126
Mailing Address - Street 1:9719 CONCORD PASS
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-3706
Mailing Address - Country:US
Mailing Address - Phone:615-319-8126
Mailing Address - Fax:
Practice Address - Street 1:15421 RED HILL AVE
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7309
Practice Address - Country:US
Practice Address - Phone:714-408-7628
Practice Address - Fax:855-884-6642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY508023336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5643728OtherNCPDP PROVIDER IDENTIFICATION NUMBER