Provider Demographics
NPI:1215158753
Name:INNOVATIVE PHARMACY SOLUTIONS
Entity type:Organization
Organization Name:INNOVATIVE PHARMACY SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:405-330-3619
Mailing Address - Street 1:1716 S KELLY AVE
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3624
Mailing Address - Country:US
Mailing Address - Phone:405-330-3619
Mailing Address - Fax:405-330-5621
Practice Address - Street 1:1716 S KELLY AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3624
Practice Address - Country:US
Practice Address - Phone:405-330-3619
Practice Address - Fax:405-330-5621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK3721847OtherNCPDP
OK3721847OtherNCPDP