Healthcare Provider Details

I. General information

NPI: 1558055194
Provider Name (Legal Business Name): INNOVATIVE PHARMACY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7381 114TH AVE STE 402
LARGO FL
33773-5131
US

IV. Provider business mailing address

7381 114TH AVE STE 402
LARGO FL
33773-5131
US

V. Phone/Fax

Practice location:
  • Phone: 727-268-8982
  • Fax:
Mailing address:
  • Phone: 727-268-8982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: AMY MULDERRY
Title or Position: PRESIDENT
Credential:
Phone: 972-588-1000