1295816387 NPI number — COMPOUNDING CORNER INC.

Table of content: (NPI 1295816387)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295816387 NPI number — COMPOUNDING CORNER INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPOUNDING CORNER 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:
MULLER COMPOUNDING CORNER INC.
Provider Other Organization Name Type Code:
4
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:
1295816387
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 217
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LACOMBE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70445-0217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-882-6333
Provider Business Mailing Address Fax Number:
985-882-5307

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
61000 SEVENTEENTH ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LACOMBE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70445-0217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-882-6333
Provider Business Practice Location Address Fax Number:
985-882-5307
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MULLER
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
BELTHAZAR
Authorized Official Title or Position:
DIRECTOR/PHARMACIST IN CHARGE
Authorized Official Telephone Number:
985-882-6333

Provider Taxonomy Codes

  • Taxonomy code: 3336C0004X , with the licence number:  4548 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1928398 . This is a "NAPB" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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