Organization
SOUTHERN TIER INFUSION INC
Active
Organization
SOUTHERN TIER INFUSION INC
Active
Other names
Pharmacy Innovations
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD B MOON PHARMD (OWNER PHARMACIST)
(716) 720-5121
Entity
Organization
Contact information
Practice address
8687 LOUETTA RD STE 150, SPRING, TX 77379-6672
(281) 251-0888
(716) 708-6248
Mailing address
2535 JOHNS PL, JAMESTOWN, NY 14701-9210
(716) 720-5121
(716) 708-6248
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
148107
—
TX
01
—
25732
STATE BOARD LICENSE
TX
01
—
90154967
DPS
TX
Enumeration date
01/26/2007
Last updated
03/07/2023
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