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General NPI Number Information
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NPI Number | 1083829170
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Entity Type | Organization
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Legal Business Name | INNOVATIVE COMPOUNDING PHARMACY
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 08/03/2007
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Provider Practice Location Address
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Address Line | 820 WALES DR SUITE 3
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City | FOLSOM
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State | CA
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Zip | 95630-5546
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Country | US
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Telephone | 916-984-9222
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Fax | 916-458-8267
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Provider Business Mailing Address
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Address Line | 820 WALES DR SUITE 3
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City | FOLSOM
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State | CA
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Zip | 95630-5546
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Country | US
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Telephone | 916-984-9222
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Fax | 916-458-8267
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Authorized Official
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Title or Position | OWNERPHARMACIST
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Name | DR. ANNA RASHIDI
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Credential | PHARMD
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Telephone | 916-984-9222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | PHY 48417
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License Number State | CA
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