Provider Demographics
NPI:1285095497
Name:INTEGRATED PHARMACY, LLC
Entity type:Organization
Organization Name:INTEGRATED PHARMACY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:BELLUOMINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-476-8000
Mailing Address - Street 1:7815 N PALM AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-5530
Mailing Address - Country:US
Mailing Address - Phone:559-476-8000
Mailing Address - Fax:
Practice Address - Street 1:516 DENVER ST
Practice Address - Street 2:SUITE 200
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-2110
Practice Address - Country:US
Practice Address - Phone:866-499-1138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX307073336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy