Organization
INNOVATIVE SERVICES INC
Active
Parent organization
UPSTATE NEWCO LLC
Other names
Upstate Homecare, LUX Infusion 9
Organization subpart
Yes
Provider details
NPI number
Legal business name
UPSTATE NEWCO LLC
Authorized official
MR. EDWARD P KRAMM (CHIEF EXECUTIVE OFFICER)
(913) 515-6719
Entity
Organization
Contact information
Practice address
200 AIRPARK DR STE 60, ROCHESTER, NY 14624-5716
(585) 328-2050
(585) 394-2058
Mailing address
PO BOX 931769, ATLANTA, GA 31193-1769
(585) 423-9580
(585) 423-9488
Taxonomy
Speciality
Code
Description
License number
State
251F00000X
Home Infusion Agency
—
—
251J00000X
Nursing Care Agency
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
333600000X
Pharmacy
028984
NY
3336H0001X
Home Infusion Therapy Pharmacy
Primary
028984
NY
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
028984
PHARMACY LICENSE
NY
05
—
02985142
—
NY
01
—
0701L003
DOH LICENSE
NY
01
—
3358771
NCPDP
NY
01
—
6853
MCD PIN
NY
01
—
AAHD
MCD ETIN
NY
Enumeration date
05/24/2006
Last updated
04/29/2026
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