# INNOVATIVE CARE PHARMACY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** INNOVATIVE CARE PHARMACY LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528055324
- **Authorized official:** BRAD LANHAM (PRESIDENT/CEO)
- **Authorized official phone:** (817) 328-6421

## Contact information

- **Practice address:** 9196 E EMERALD ST, STE 110, BOISE, ID 83704
- **Practice address phone:** (208) 323-1259
- **Practice address fax:** (208) 323-5666
- **Mailing address:** 9196 E EMERALD ST, STE 110, BOISE, ID 83704
- **Mailing address phone:** (208) 323-1259
- **Mailing address fax:** (208) 323-8934

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | 2304LS | ID | Yes |

## Other

- **Enumeration date:** 10/05/2005
- **Last updated:** 05/07/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2021877 | PK | — |
| 05 | — | 80668600 | — | ID |