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General NPI Number Information
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NPI Number | 1407966229
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Entity Type | Organization
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Legal Business Name | INNOVATIVE CARE PHARMACY
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 09/25/2009
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Provider Practice Location Address
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Address Line | 9196 W EMERALD ST STE 110
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City | BOISE
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State | ID
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Zip | 83704-0679
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Country | US
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Telephone | 208-323-1259
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Fax | 208-323-8934
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Provider Business Mailing Address
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Address Line | 9196 W EMERALD ST STE 110
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City | BOISE
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State | ID
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Zip | 83704-0679
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Country | US
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Telephone | 208-323-1259
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Fax | 208-323-8934
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Authorized Official
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Title or Position | VP PURCHASING
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Name | SHEILA MOORE
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Credential |
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Telephone | 817-552-7630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 2303CP
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License Number State | ID
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