1104062181 NPI number — QUALITY COMPOUNDING AND SPECIALTY RX LTD

Table of content: (NPI 1104062181)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104062181 NPI number — QUALITY COMPOUNDING AND SPECIALTY RX LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUALITY COMPOUNDING AND SPECIALTY RX LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
QUALITY COMPOUNDING AND SPECIALTY RX
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104062181
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8571 FOXWOOD CT
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
POLAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44514-4313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-318-3926
Provider Business Mailing Address Fax Number:
330-318-3927

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7160 WARREN SHARON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKFIELD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44403-9657
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-505-1064
Provider Business Practice Location Address Fax Number:
330-505-1068
Provider Enumeration Date:
12/23/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MCDERMOTT
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
Authorized Official Title or Position:
SVP OPERATIONS
Authorized Official Telephone Number:
330-318-3926

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: 021918100 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2927579 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2118709 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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