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General NPI Number Information
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NPI Number | 1609417112
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Entity Type | Organization
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Legal Business Name | INNOVATION PHARMACY INC
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Dates
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Enumeration Date | 10/05/2019
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Last Update Date | 12/25/2019
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Provider Practice Location Address
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Address Line | 1097 LOUDEN
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City | COHOES
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State | NY
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Zip | 12047-4903
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Country | US
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Telephone | 518-783-1210
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 12552
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City | ALBANY
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State | NY
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Zip | 12212-2552
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | OSAMAH AWAD
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Credential | PHARMD
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Telephone | 518-336-6600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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