1558531244 NPI number — A & J COMPOUNDING INC

Table of content: (NPI 1558531244)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558531244 NPI number — A & J COMPOUNDING INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A & J COMPOUNDING INC
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:
JOHNSON COMPOUNDING & WELLNESS CENTER
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:
1558531244
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
577 MAIN STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALTHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02452
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-893-3870
Provider Business Mailing Address Fax Number:
781-899-1172

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
577 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALTHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02452-5527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-893-3870
Provider Business Practice Location Address Fax Number:
781-899-1172
Provider Enumeration Date:
03/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WALCZYK
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
B
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
781-893-3870

Provider Taxonomy Codes

  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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