Healthcare Provider Details

I. General information

NPI: 1366803512
Provider Name (Legal Business Name): PHARMACY INNOVATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2016
Last Update Date: 01/31/2020
Certification Date: 01/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 GARFIELD ST
TUPELO MS
38801-6339
US

IV. Provider business mailing address

715 GARFIELD ST
TUPELO MS
38801-6339
US

V. Phone/Fax

Practice location:
  • Phone: 855-612-1385
  • Fax: 855-612-1386
Mailing address:
  • Phone: 855-612-1385
  • Fax: 855-612-1386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number14763
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: AMY COCHRAN
Title or Position: PHARMACIST IN CHARGE
Credential:
Phone: 855-612-1385