INNOVATION COMPOUNDING, INC
Suppliers at Pine Mountain Rd, Kennesaw, GA

License number
Georgia PHRE009149
Category
Suppliers
Type
Compounding Pharmacy
Owner
Name: SHAWN EDWARD HODGES PHARMD
Title: OWNER
Phone: (770) 421-1399
Address
Address
6095 Pine Mountain Rd NW STE 108, Kennesaw, GA 30152
National Provider ID: 1710157342
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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INNOVATION COMPOUNDING, INC

6095 Pne Mtn Rd NW #108, Kennesaw, GA

Registration:
Mar 3, 2014
Description:
COMPOUNDING PHARMACY
State ID:
0288708
Business type:
Foreign Profit Corporation
Agent:
Incorp Services Inc,6095 Pne Mtn Rd NW #108, Kennesaw, GA (Mailing)
5319 Main St, Manchester Center, VT (Physical)
PO Box 1091, Manchester Center, VT (Mailing)

INNOVATION COMPOUNDING, INC

6095 Pne Mtn Rd, Kennesaw, GA 30152

Industry:
Ret Drugs/Sundries
Registration:
Jan 31, 2007
State ID:
07011956
Business type:
Domestic Profit Corporation
Entity State:
FL
Vice Presidents:
Shawn Hodges (Secretary, President, Vice President), 6095 Pne Mtn Rd, Kennesaw, GA 30152 (Physical),Joseph C. Aaron Vice President, inactive
Agent:
Richard H. Bennett,9065 Bluffview Trce, Roswell, GA (Physical)

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