Healthcare Provider Details

I. General information

NPI: 1255045118
Provider Name (Legal Business Name): MUSELY COMPOUNDING PHARMACY EAST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2023
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 SHAWNEE NORTH DR STE 600
SUWANEE GA
30024-6714
US

IV. Provider business mailing address

305 SHAWNEE NORTH DR STE 600
SUWANEE GA
30024-6714
US

V. Phone/Fax

Practice location:
  • Phone: 470-328-3001
  • Fax:
Mailing address:
  • Phone: 470-328-3001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: STEVE BUCHANAN
Title or Position: MANAGER
Credential:
Phone: 925-708-1881