Basic Information
Provider Information | |||||||||
NPI: | 1245416262 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | INSTITUTIONAL PHARMACY SOLUTIONS LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | INSTITUTIONAL PHARMACY SERVICES | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 242305 | ||||||||
Address2: |   | ||||||||
City: | MONTGOMERY | ||||||||
State: | AL | ||||||||
PostalCode: | 361242305 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3343567627 | ||||||||
FaxNumber: | 3343568347 | ||||||||
Practice Location | |||||||||
Address1: | 820 W WASHINGTON ST | ||||||||
Address2: |   | ||||||||
City: | EUFAULA | ||||||||
State: | AL | ||||||||
PostalCode: | 360271822 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3346887000 | ||||||||
FaxNumber: | 3343568347 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/22/2008 | ||||||||
LastUpdateDate: | 02/14/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MIMS | ||||||||
AuthorizedOfficialFirstName: | DANIEL | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
AuthorizedOfficialTelephone: | 3343567627 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | RPH | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336I0012X | 180158 | AL | Y |   | Suppliers | Pharmacy | Institutional Pharmacy |
ID Information
ID | Type | State | Issuer | Description | 0135031 | 01 |   | NCPDP PROVIDER IDENTIFICATION NUMBER | OTHER |