Healthcare Provider Details

I. General information

NPI: 1346564176
Provider Name (Legal Business Name): PREFERRED COMPOUNDING PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2010
Last Update Date: 09/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17547 CHATSWORTH ST
GRANADA HILLS CA
91344-5720
US

IV. Provider business mailing address

17547 CHATSWORTH ST
GRANADA HILLS CA
91344-5720
US

V. Phone/Fax

Practice location:
  • Phone: 818-360-5004
  • Fax: 818-360-5004
Mailing address:
  • Phone: 818-360-5004
  • Fax: 818-360-5005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number54528
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TREPHENE BROWN
Title or Position: OWNER
Credential:
Phone: 818-360-5004