Organization
INNOVATIVE CARE PHARMACY
Active
Other names
INNOVATIVE CARE PHARMACY LLC
Organization subpart
No
Provider details
NPI number
Authorized official
SHEILA MOORE (VP PURCHASING)
(817) 552-7630
Entity
Organization
Contact information
Practice address
9196 W EMERALD ST, STE 110, BOISE, ID 83704-0679
(208) 323-1259
(208) 323-8934
Mailing address
9196 W EMERALD ST, STE 110, BOISE, ID 83704-0679
(208) 323-1259
(208) 323-8934
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
2303CP
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1307619
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
806967700
—
ID
Enumeration date
08/30/2006
Last updated
09/25/2009
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