Healthcare Provider Details

I. General information

NPI: 1790132280
Provider Name (Legal Business Name): INNOVATIVE PHARMACEUTICAL SOLUTIONS GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 06/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 GENOA BUSINESS PARK DR STE 120A SUITE 120-A
BRIGHTON MI
48114-7372
US

IV. Provider business mailing address

2250 GENOA BUSINESS PARK DR SUITE 120-A
BRIGHTON MI
48114-7371
US

V. Phone/Fax

Practice location:
  • Phone: 517-980-9875
  • Fax:
Mailing address:
  • Phone: 517-980-9875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number5301010935
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH MARTINEZ
Title or Position: PRESIDENT
Credential:
Phone: 517-980-9875