1528028388 NPI number — PRESCRIPTION COMPOUNDING SPECIALISTS INC

Table of content: (NPI 1780689802)

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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