Healthcare Provider Details

I. General information

NPI: 1215143490
Provider Name (Legal Business Name): COMPOUND PHARMACEUTICAL TECHNOLOGIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 05/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1048 STANTON RD SUITE B
DAPHNE AL
36526-4294
US

IV. Provider business mailing address

1048 STANTON RD SUITE B
DAPHNE AL
36526-4294
US

V. Phone/Fax

Practice location:
  • Phone: 251-626-2820
  • Fax:
Mailing address:
  • Phone: 251-626-2820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number112942
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number201542
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number112942
License Number StateAL

VIII. Authorized Official

Name: MR. JOHN K. HART II
Title or Position: PRESIDENT
Credential:
Phone: 251-626-2820