Organization
INNOVATIVE INTRATHECAL SOLUTIONS INC
Active
Other names
INNOVATIVE COMPOUNDING PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY BARRACK RPH (PRESIDENT)
(951) 304-9530
Entity
Organization
Contact information
Practice address
41538 EASTMAN DR, MURRIETA, CA 92562-8007
(951) 304-9530
(951) 304-9540
Mailing address
41538 EASTMAN DR, MURRIETA, CA 92562-8007
(951) 304-9530
(951) 304-9540
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY49935
CA
3336C0004X
Compounding Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1997382
PK
—
05
—
PHA45898
—
CA
Enumeration date
12/26/2006
Last updated
06/20/2016
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