Provider Demographics
NPI:1215912886
Name:INNOVATIVE HEALTH SYSTEMS INC
Entity type:Organization
Organization Name:INNOVATIVE HEALTH SYSTEMS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARM
Authorized Official - Phone:912-685-2803
Mailing Address - Street 1:150 S LEROY ST
Mailing Address - Street 2:
Mailing Address - City:METTER
Mailing Address - State:GA
Mailing Address - Zip Code:30439-4631
Mailing Address - Country:US
Mailing Address - Phone:912-685-2803
Mailing Address - Fax:912-685-3777
Practice Address - Street 1:150 S LEROY ST
Practice Address - Street 2:
Practice Address - City:METTER
Practice Address - State:GA
Practice Address - Zip Code:30439-4631
Practice Address - Country:US
Practice Address - Phone:912-685-2803
Practice Address - Fax:912-685-3777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-07
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163WD0400X, 333600000X
GAPHRE0082513336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Single Specialty
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00805956AMedicaid
GA00805956BMedicaid
2020140OtherPK
1240690001Medicare NSC