Healthcare Provider Details

I. General information

NPI: 1952875924
Provider Name (Legal Business Name): INNOVATIVE SOLUTIONS R & D LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2019
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 EURY LN
SOMERSET KY
42501-4115
US

IV. Provider business mailing address

465 BOSTON RD
MONTICELLO KY
42633-8321
US

V. Phone/Fax

Practice location:
  • Phone: 800-401-8213
  • Fax: 800-401-8213
Mailing address:
  • Phone: 606-341-3518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSHUA GLEN CROWLEY
Title or Position: OWNER
Credential: PHARM.D.
Phone: 606-341-3518