NPIMap

Organization Active NPI

Innovation Compounding Pharmacy, LLC

Doing business as Innovation Compounding

  • Pharmacy
  • Kennesaw, GA
National Provider Identifier
1710157342
Registry record updated Jul 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
Legal business name
INNOVATION COMPOUNDING PHARMACY, LLC
Doing business as
Innovation Compounding
Practice address
3330 Chastain Meadows Pkwy NW
Suite 100
Kennesaw, GA 30144
Phone
(800) 547-1399
Fax
(866) 635-2329
NPI assigned
Mar 11, 2008
Last updated
Jul 30, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2026

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

Authorized official

Name
Bart Zachary Anderson III, PHARMD
Title
General Manager/Pharmacist-in-Charg
Phone
(800) 547-1399

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X Primary
Compounding Pharmacy 3336C0004X
Compounding Pharmacy 3336C0004X PHRE009149 GA

Addresses

Primary practice location

3330 Chastain Meadows Pkwy NW
Suite 100
Kennesaw, GA 30144

Mailing address

3330 Chastain Meadows Pkwy NW
Suite 100
Kennesaw, GA 30144
Phone (800) 547-1399

Other names 1

  • Innovation Compounding Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201209002689 GA Part B Supplier - Mass Immunization (Roster Biller Only) 8022420496 Practice locations: Kennesaw, GA

National Provider Directory

National Provider Directory

Locations

3330 Chastain Meadows Pkwy NW
#100
Kennesaw, GA 30144
Phone (770) 421-1399

6095 Pine Mountain Rd NW
Ste 108
Kennesaw, GA 30152
Phone (770) 421-1399

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1205193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785369600000",
    "number": "1710157342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3330 CHASTAIN MEADOWS PKWY NW",
            "address_2": "SUITE 100",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "30144",
            "telephone_number": "800-547-1399",
            "fax_number": "866-635-2329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3330 CHASTAIN MEADOWS PKWY NW",
            "address_2": "SUITE 100",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "30144",
            "telephone_number": "800-547-1399",
            "fax_number": "866-635-2329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATION COMPOUNDING PHARMACY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-11",
        "last_updated": "2026-07-30",
        "certification_date": "2026-07-30",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "BART",
        "authorized_official_middle_name": "ZACHARY",
        "authorized_official_title_or_position": "GENERAL MANAGER/PHARMACIST-IN-CHARG",
        "authorized_official_telephone_number": "800-547-1399",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "GA",
            "license": "PHRE009149",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Innovation Compounding",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kennesaw, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2026; 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.