Healthcare Provider Details

I. General information

NPI: 1457084253
Provider Name (Legal Business Name): IVATION PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2022
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 N HEATHERWILDE BLVD STE 220
PFLUGERVILLE TX
78660-4192
US

IV. Provider business mailing address

305 N HEATHERWILDE BLVD STE 220
PFLUGERVILLE TX
78660-4192
US

V. Phone/Fax

Practice location:
  • Phone: 512-549-8519
  • Fax: 866-676-5890
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL NAMETH
Title or Position: EVP, CLOUD AND SPECIALTY PHARMACY
Credential:
Phone: 412-266-5515