Healthcare Provider Details

I. General information

NPI: 1649516113
Provider Name (Legal Business Name): NATIONAL COMPOUNDING COMPANY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2013
Last Update Date: 01/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1824 59TH ST W
BRADENTON FL
34209-4630
US

IV. Provider business mailing address

1824 59TH ST W
BRADENTON FL
34209-4630
US

V. Phone/Fax

Practice location:
  • Phone: 941-792-2688
  • Fax: 941-254-4937
Mailing address:
  • Phone: 941-792-2688
  • Fax: 941-254-4937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH26591
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BRAD LONG
Title or Position: PRESIDENT
Credential:
Phone: 941-792-2688