Healthcare Provider Details

I. General information

NPI: 1447809082
Provider Name (Legal Business Name): EXPRESS COMPOUNDING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2019
Last Update Date: 09/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2086 US HIGHWAY 93 N STE 110
VICTOR MT
59875-9209
US

IV. Provider business mailing address

PO BOX 538
CORVALLIS MT
59828-0538
US

V. Phone/Fax

Practice location:
  • Phone: 406-529-6182
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JOHN WATT
Title or Position: PHARMACIST
Credential: RPH
Phone: 406-529-6182