MEDICARE: INNOVATIVE SERVICE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251F00000X	Home Infusion Agency
2	333600000X	Pharmacy
3	3336H0001X	Home Infusion Therapy Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3358771	OTHER	NY	NCPDP
2	028984	OTHER	NY	PHARMACY LICENSE
3	0701L003	OTHER	NY	DOH LICENSE NUMBER

General Provider Information

NPI Number	:	1851567812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNOVATIVE SERVICE INC

Provider Business Mailing Address
First Line	:	7506 STATE ROUTE 5
Second Line	:
City	:	CLINTON
State	:	NY
Zip	:	13323-3654
Country	:	US
Telephone Number	:	585-423-9580
Fax Number	:	315-853-6087

Provider Business Practice Location Address
First Line	:	200 AIRPARK DR STE 60
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14624-5716
Country	:	US
Telephone Number	:	585-328-2050
Fax Number	:	585-328-2058

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. EDWARD P KRAMM
Credential	:
Telephone Number	:	913-515-6719

Provider Enumeration Date	:	04/30/2008
Last Update Date	:	03/17/2026

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Directions to “INNOVATIVE SERVICE INC ” Practice Location

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