Healthcare Provider Details

I. General information

NPI: 1225470016
Provider Name (Legal Business Name): CLINICAL COMPOUNDING SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2013
Last Update Date: 07/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3373 MAYFLOWER LN
SOUTHSIDE AL
35907-7965
US

IV. Provider business mailing address

3373 MAYFLOWER LN
SOUTHSIDE AL
35907-7965
US

V. Phone/Fax

Practice location:
  • Phone: 256-490-7760
  • Fax: 256-442-3299
Mailing address:
  • Phone: 256-490-7760
  • Fax: 256-442-3299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16217
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL S BAKER
Title or Position: OWNER
Credential: PHARM D
Phone: 256-490-7760