Innovative Pharmacy LLC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

License

PP482279 Issued in PA

Legal business name

INNOVATIVE PHARMACY LLC

Practice address

2014 Ford Rd Ste B
Bristol, PA 19007-6743

Phone

(267) 878-0492

Fax

(267) 878-0534

NPI assigned

Jun 14, 2012

Organization subpart

No

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

Authorized official

Name

Evan Landa

Title

Managing Member

Phone

(908) 216-6680

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• Innovative Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in PA2 enrollments

Enrollment records 2

Locations

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

{
    "created_epoch": "1339632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1345593600000",
    "number": "1497017461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2014 FORD ROAD",
            "address_2": "UNIT B",
            "city": "BRISTOL",
            "state": "PA",
            "postal_code": "19007",
            "telephone_number": "267-878-0492",
            "fax_number": "267-878-0534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2014 FORD RD STE B",
            "city": "BRISTOL",
            "state": "PA",
            "postal_code": "190076743",
            "telephone_number": "267-878-0492",
            "fax_number": "267-878-0534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-14",
        "last_updated": "2012-08-22",
        "status": "A",
        "authorized_official_last_name": "LANDA",
        "authorized_official_first_name": "EVAN",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "908-216-6680"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "PA",
            "license": "PP482279",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "3997701",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Innovative Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Long Term Care Pharmacy in Bristol, PA
• Providers in Bristol, PA by specialty
• Long Term Care Pharmacy in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.