Organization
IONIA PHARMACY, LLC
Active
Other names
Ionia Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
ALISON CHERNEY (CEO)
(615) 319-8126
Entity
Organization
Contact information
Practice address
15421 RED HILL AVE, TUSTIN, CA 92780-7309
(714) 408-7628
(855) 884-6642
Mailing address
9719 CONCORD PASS, BRENTWOOD, TN 37027-3706
(615) 319-8126
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
PHY50802
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5643728
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
05/09/2012
Last updated
05/09/2012
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