Healthcare Provider Details

I. General information

NPI: 1265554562
Provider Name (Legal Business Name): RS COMPOUNDING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 04/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12617 RACE TRACK RD
TAMPA FL
33626-1331
US

IV. Provider business mailing address

12617 RACE TRACK RD
TAMPA FL
33626-1331
US

V. Phone/Fax

Practice location:
  • Phone: 813-925-8200
  • Fax: 813-925-8933
Mailing address:
  • Phone: 813-925-8200
  • Fax: 813-925-8933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH20981
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RENIER GOBEA
Title or Position: OWNER/MANAGER
Credential:
Phone: 813-925-8200