Healthcare Provider Details

I. General information

NPI: 1750148375
Provider Name (Legal Business Name): INTERGRATED PHARMCEUTICAL SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1478 N WILSON AVE
BARTOW FL
33830-3373
US

IV. Provider business mailing address

PO BOX 46216
TAMPA FL
33646-0102
US

V. Phone/Fax

Practice location:
  • Phone: 863-537-6694
  • Fax: 863-537-6579
Mailing address:
  • Phone: 863-537-6694
  • Fax: 863-537-6579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ENOCH A OFOSU
Title or Position: MGR
Credential: PHARM. D
Phone: 863-537-6694