Provider Demographics
NPI:1447789227
Name:INNOVATIVE EXPRESS PHARMACY LLC
Entity type:Organization
Organization Name:INNOVATIVE EXPRESS PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ILYAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNSHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-234-5344
Mailing Address - Street 1:PO BOX 82510
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70598-2510
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:99 W MARTIAL AVE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6583
Practice Address - Country:US
Practice Address - Phone:337-408-8003
Practice Address - Fax:337-267-3293
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INNOVATIVE EXPRESS PHARMACY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-06
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site