# INNOVATIVE PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Innovative Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497017461
- **Authorized official:** EVAN LANDA (MANAGING MEMBER)
- **Authorized official phone:** (908) 216-6680

## Contact information

- **Practice address:** 2014 FORD RD STE B, BRISTOL, PA 19007-6743
- **Practice address phone:** (267) 878-0492
- **Practice address fax:** (267) 878-0534
- **Mailing address:** 2014 FORD ROAD, UNIT B, BRISTOL, PA 19007
- **Mailing address phone:** (267) 878-0492
- **Mailing address fax:** (267) 878-0534

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | PP482279 | PA | Yes |

## Other

- **Enumeration date:** 06/14/2012
- **Last updated:** 08/22/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 3997701 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |