Healthcare Provider Details

I. General information

NPI: 1831341577
Provider Name (Legal Business Name): NATIOAL COMPOUNDING INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2008
Last Update Date: 03/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1851 LANGLEY AVE
IRVINE CA
92614-5623
US

IV. Provider business mailing address

250 E YALE LOOP SUITE C
IRVINE CA
92604-4697
US

V. Phone/Fax

Practice location:
  • Phone: 866-624-6241
  • Fax: 866-615-5352
Mailing address:
  • Phone: 866-624-6241
  • Fax: 866-615-5352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY48441
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TINA SULIR-SAADEH
Title or Position: PRES
Credential:
Phone: 949-551-7195