Healthcare Provider Details

I. General information

NPI: 1366889685
Provider Name (Legal Business Name): CENTRAL COMPOUNDING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2013
Last Update Date: 05/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 RTE 33 UNIT #4
FARMINGDALE NJ
07727-4033
US

IV. Provider business mailing address

1306 RTE 33 UNIT #4
FARMINGDALE NJ
07727-4033
US

V. Phone/Fax

Practice location:
  • Phone: 732-938-5545
  • Fax:
Mailing address:
  • Phone: 732-938-5545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number28RS00658700
License Number StateNJ

VIII. Authorized Official

Name: KENNETH KALADA
Title or Position: OWNER
Credential:
Phone: 732-938-5545