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Contact Information

INNOVATIVE CARE PHARMACY
9196 E EMERALD ST
STE 110
BOISE, ID83704
 Phone: 208-323-1259
 Fax: 208-323-5666
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Long Term Care Pharmacy

3336L0003X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for INNOVATIVE CARE PHARMACY

NPI # 1528055324
LBN Legal business name INNOVATIVE CARE PHARMACY
Authorized official BRAD LANHAM - (PRESIDENT/CEO)
Entity Organization
Organization subpart 1 No
Enumeration date 10/05/2005
Last updated 05/07/2013 - About 13 years ago
Identifiers
ID License # 2304LS
ID Medicaid 80668600
Other 2021877 PK
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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