Innovative Compounding Pharmacy

Primary specialty

Compounding PharmacyTaxonomy code 3336C0004X

License

PHY 48417 Issued in CA

Legal business name

INNOVATIVE COMPOUNDING PHARMACY

Practice address

820 Wales Dr
Suite 3
Folsom, CA 95630-5546

Phone

(916) 984-9222

Fax

(916) 458-8267

NPI assigned

May 11, 2007

Last updated

Aug 3, 2007By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Anna Rashidi, PHARMDNPI 1669868121

Title

Ownerpharmacist

Phone

(916) 984-9222

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Anna Rashidi, PHARMD

  • Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
  • Folsom, CA
  • NPI 1669868121
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1186099200000",
    "number": "1083829170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 WALES DR",
            "address_2": "SUITE 3",
            "city": "FOLSOM",
            "state": "CA",
            "postal_code": "956305546",
            "telephone_number": "916-984-9222",
            "fax_number": "916-458-8267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 WALES DR",
            "address_2": "SUITE 3",
            "city": "FOLSOM",
            "state": "CA",
            "postal_code": "956305546",
            "telephone_number": "916-984-9222",
            "fax_number": "916-458-8267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE COMPOUNDING PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-11",
        "last_updated": "2007-08-03",
        "status": "A",
        "authorized_official_last_name": "RASHIDI",
        "authorized_official_first_name": "ANNA",
        "authorized_official_title_or_position": "OWNERPHARMACIST",
        "authorized_official_telephone_number": "916-984-9222",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "CA",
            "license": "PHY 48417",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Compounding Pharmacy in Folsom, CA
• Providers in Folsom, CA by specialty
• Compounding Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.