Healthcare Provider Details

I. General information

NPI: 1891150637
Provider Name (Legal Business Name): IPS INTEGRATED PHARMACY SPECIALS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2015
Last Update Date: 08/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CORPORATE DR
ORANGEBURG NY
10962-2614
US

IV. Provider business mailing address

10 CORPORATE DR
ORANGEBURG NY
10962-2614
US

V. Phone/Fax

Practice location:
  • Phone: 845-359-3300
  • Fax: 845-359-3302
Mailing address:
  • Phone: 845-359-3300
  • Fax: 845-359-3302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number034012
License Number StateNY

VIII. Authorized Official

Name: MNESHA PATEL
Title or Position: OWNER/PHARMACIST-IN-CHARGE
Credential:
Phone: 845-359-3300