Organization
INNOVATIVE CARE PHARMACY
Active
Other names
INNOVATIVE CARE PHARMACY LLC
Organization subpart
No
Provider details
NPI number
Authorized official
BRAD LANHAM (PRESIDENT/CEO)
(817) 328-6421
Entity
Organization
Contact information
Practice address
9196 E EMERALD ST, STE 110, BOISE, ID 83704
(208) 323-1259
(208) 323-5666
Mailing address
9196 E EMERALD ST, STE 110, BOISE, ID 83704
(208) 323-1259
(208) 323-8934
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
2304LS
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2021877
PK
—
05
—
80668600
—
ID
Enumeration date
10/05/2005
Last updated
05/07/2013
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