Healthcare Provider Details

I. General information

NPI: 1033594015
Provider Name (Legal Business Name): FEEL GOOD COMPOUNDERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2015
Last Update Date: 07/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 DONDEE ST STE C
PACIFICA CA
94044-3278
US

IV. Provider business mailing address

411 DONDEE ST STE C
PACIFICA CA
94044-3278
US

V. Phone/Fax

Practice location:
  • Phone: 650-898-8221
  • Fax: 650-898-8147
Mailing address:
  • Phone: 650-898-8221
  • Fax: 650-898-8147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPHY52495
License Number StateCA

VIII. Authorized Official

Name: EDDIE LAU
Title or Position: PHARMACIST/OWNER
Credential:
Phone: 650-898-8221