| Organization Name: | INNOVATIVE COMPOUNDING PHARMACY |
| NPI Number: | 1083829170 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANNA RASHIDI (OWNERPHARMACIST) |
| Mailing Address: | 820 Wales Dr Suite 3 Folsom |
| State: | CA US |
| Postal Code: | 956305546 |
| Phone Number: | 9169849222 |
| Fax Number: | 9164588267 |
| NPI Enumeration Date: | 05/11/2007 |
| NPI Last Update Date: | 08/03/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3336C0004X |
| License Number: | PHY 48417 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Pharmacy |
| Taxonomy Specialization: | Compounding Pharmacy |
| Taxonomy Definition: | A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner |