1528028388 NPI number — PRESCRIPTION COMPOUNDING SPECIALISTS INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528028388 NPI number — PRESCRIPTION COMPOUNDING SPECIALISTS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRESCRIPTION COMPOUNDING SPECIALISTS 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:
D/B/A MEDICAL CENTER PHARMACY
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:
1528028388
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
99-115 AIEA HEIGHTS DR
Provider Second Line Business Mailing Address:
#301
Provider Business Mailing Address City Name:
AIEA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96701-3924
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-487-9988
Provider Business Mailing Address Fax Number:
808-484-0042

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
99-115 AIEA HEIGHTS DR
Provider Second Line Business Practice Location Address:
#205
Provider Business Practice Location Address City Name:
AIEA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96701-3924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-487-9988
Provider Business Practice Location Address Fax Number:
808-424-0042
Provider Enumeration Date:
03/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GREGORY
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
808-487-9988

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  PHY-646 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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