Innovative Care Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

2303CP Issued in ID

Legal business name

INNOVATIVE CARE PHARMACY

Practice address

9196 W Emerald St
Ste 110
Boise, ID 83704-0679

Phone

(208) 323-1259

Fax

(208) 323-8934

NPI assigned

Aug 30, 2006

Organization subpart

No

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

Authorized official

Name

Sheila Moore

Title

VP Purchasing

Phone

(817) 552-7630

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• INNOVATIVE CARE PHARMACY LLC Doing business as

Locations

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1253836800000",
    "number": "1407966229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9196 W EMERALD ST",
            "address_2": "STE 110",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837040679",
            "telephone_number": "208-323-1259",
            "fax_number": "208-323-8934"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9196 W EMERALD ST",
            "address_2": "STE 110",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837040679",
            "telephone_number": "208-323-1259",
            "fax_number": "208-323-8934"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE CARE PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2009-09-25",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "SHEILA",
        "authorized_official_title_or_position": "VP PURCHASING",
        "authorized_official_telephone_number": "817-552-7630"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "ID",
            "license": "2303CP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806967700",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "1307619",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "INNOVATIVE CARE PHARMACY LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Boise, ID
• Providers in Boise, ID by specialty
• Community/Retail Pharmacy in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.