Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days.
Organization
INNOVATIVE RX INC
Active
Organization
INNOVATIVE RX INC
Active
Other names
COSTA MESA COMPOUNDING PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MAYANK SHAN (PRESIDENT)
(949) 642-0106
Entity
Organization
Contact information
Practice address
275 VICTORIA ST, STE 1F, COSTA MESA, CA 92627-1906
(949) 642-0106
(949) 642-5039
Mailing address
275 VICTORIA ST, STE 1F, COSTA MESA, CA 92627-1906
(949) 642-0106
(949) 642-5039
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
PHY48847
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0525468
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/31/2006
Last updated
10/01/2009
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up