Healthcare Provider Details

I. General information

NPI: 1578486312
Provider Name (Legal Business Name): SCIENTIA COMPOUNDING PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1706 W 10TH PL
TEMPE AZ
85281-5212
US

IV. Provider business mailing address

1706 W 10TH PL
TEMPE AZ
85281-5212
US

V. Phone/Fax

Practice location:
  • Phone: 901-483-1512
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SUJIN KIM
Title or Position: PHARMACIST IN CHARGE
Credential: PHARMD
Phone: 623-271-3406