Healthcare Provider Details

I. General information

NPI: 1467495234
Provider Name (Legal Business Name): INNOVATIVE PHARMACY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312B MARION AVE
MCCOMB MS
39648-2708
US

IV. Provider business mailing address

312B MARION AVE
MCCOMB MS
39648-2708
US

V. Phone/Fax

Practice location:
  • Phone: 601-684-4127
  • Fax: 601-684-8479
Mailing address:
  • Phone: 601-684-4127
  • Fax: 601-684-8479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number03331/02.0
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number0331/02.0
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number03331/02.0
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number03331/02.0
License Number StateMS
# 5
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number03331/02.0
License Number StateMS

VIII. Authorized Official

Name: MR. JOE KEITH GUY
Title or Position: PRESIDENT
Credential: RPH
Phone: 601-684-4127