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Organization
INNOVATIVE PHARMACY LLC
Active
Organization
INNOVATIVE PHARMACY LLC
Active
Other names
Innovative Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
EVAN LANDA (MANAGING MEMBER)
(908) 216-6680
Entity
Organization
Contact information
Practice address
2014 FORD RD STE B, BRISTOL, PA 19007-6743
(267) 878-0492
(267) 878-0534
Mailing address
2014 FORD ROAD, UNIT B, BRISTOL, PA 19007
(267) 878-0492
(267) 878-0534
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
333600000X
Pharmacy
—
NULL
3336C0004X
Compounding Pharmacy
—
NULL
3336L0003X
Long Term Care Pharmacy
Primary
PP482279
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3997701
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
06/14/2012
Last updated
08/22/2012
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