Healthcare Provider Details

I. General information

NPI: 1336150994
Provider Name (Legal Business Name): CHAPEL HILL COMPOUNDING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 08/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 CONNER DR STE 1200
CHAPEL HILL NC
27514-7041
US

IV. Provider business mailing address

109 CONNER DR SUITE 1200
CHAPEL HILL NC
27514-7039
US

V. Phone/Fax

Practice location:
  • Phone: 919-967-8805
  • Fax: 919-967-8205
Mailing address:
  • Phone: 919-967-8805
  • Fax: 919-967-8205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number10456
License Number StateNC

VII. Legacy identifiers

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

# 1
Identifier2068643
Identifier TypeOTHER
Identifier State
Identifier IssuerPK

VIII. Authorized Official

Name: ZOE STEFANADIS
Title or Position: PHARMACIST/OWNER
Credential: BSPHARM
Phone: 919-967-8805