Healthcare Provider Details

I. General information

NPI: 1144588468
Provider Name (Legal Business Name): COMPOUNDIA PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2012
Last Update Date: 07/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

766 LAKEFIELD RD STE E
WESTLAKE VILLAGE CA
91361-2661
US

IV. Provider business mailing address

1014 S WESTLAKE BLVD STE 14-291
WESTLAKE VILLAGE CA
91361-3108
US

V. Phone/Fax

Practice location:
  • Phone: 855-371-4443
  • Fax: 805-371-4375
Mailing address:
  • Phone: 855-371-4443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number50901
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BETTY VISO
Title or Position: OWNER
Credential:
Phone: 855-371-4443