Basic Information
| Provider Information | |||||||||
| NPI: | 1336258565 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INSTITUTIONAL PHARMACY SOLUTIONS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 INTERSTATE PARK DR | ||||||||
| Address2: | SUITE 422 | ||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361095428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3343567627 | ||||||||
| FaxNumber: | 3343567647 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 E COTTONWOOD RD | ||||||||
| Address2: | |||||||||
| City: | DOTHAN | ||||||||
| State: | AL | ||||||||
| PostalCode: | 363013644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3347947373 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 09/18/2008 | ||||||||
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| AuthorizedOfficialLastName: | MIMS | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/PHARMACIST | ||||||||
| AuthorizedOfficialTelephone: | 3343567627 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336I0012X | 180152 | AL | Y | Suppliers | Pharmacy | Institutional Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 100010020 | 05 | AL | MEDICAID |