Innovative Care Pharmacy

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

License

2304LS Issued in ID

Legal business name

INNOVATIVE CARE PHARMACY

Practice address

9196 E Emerald St
Ste 110
Boise, ID 83704

Phone

(208) 323-1259

Fax

(208) 323-5666

NPI assigned

Oct 5, 2005

Organization subpart

No

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

Authorized official

Name

Brad Lanham

Title

President/Ceo

Phone

(817) 328-6421

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• INNOVATIVE CARE PHARMACY LLC Doing business as

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

{
    "created_epoch": "1128470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367884800000",
    "number": "1528055324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9196 E EMERALD ST",
            "address_2": "STE 110",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83704",
            "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 E EMERALD ST",
            "address_2": "STE 110",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83704",
            "telephone_number": "208-323-1259",
            "fax_number": "208-323-5666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE CARE PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-05",
        "last_updated": "2013-05-07",
        "status": "A",
        "authorized_official_last_name": "LANHAM",
        "authorized_official_first_name": "BRAD",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "817-328-6421"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "ID",
            "license": "2304LS",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2021877",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "80668600",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "INNOVATIVE CARE PHARMACY LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Long Term Care Pharmacy in Boise, ID
• Providers in Boise, ID by specialty
• Long Term Care Pharmacy in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2013; 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.