Basic Information
| Provider Information | |||||||||
| NPI: | 1407189350 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INSTITUTIONAL PHARMACY SOLUTIONS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 INTERSTATE PARK DR | ||||||||
| Address2: | SUITE 430 | ||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361095428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3343567627 | ||||||||
| FaxNumber: | 3343568347 | ||||||||
| Practice Location | |||||||||
| Address1: | 152 WACCAMAW MEDICAL PARK DR | ||||||||
| Address2: | |||||||||
| City: | CONWAY | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295268901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433478871 | ||||||||
| FaxNumber: | 3343568347 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2009 | ||||||||
| LastUpdateDate: | 09/10/2009 | ||||||||
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| AuthorizedOfficialLastName: | MIMS | ||||||||
| AuthorizedOfficialFirstName: | KRYSTAL | ||||||||
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| AuthorizedOfficialTitleorPosition: | COF & SENIOR VP OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 3343567627 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336I0012X | 10552 | SC | Y | Suppliers | Pharmacy | Institutional Pharmacy |
No ID Information.