Healthcare Provider Details

I. General information

NPI: 1356028484
Provider Name (Legal Business Name): LEE SILSBY COMPOUNDING PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23865 MERCANTILE RD
BEACHWOOD OH
44122-5907
US

IV. Provider business mailing address

23865 MERCANTILE RD
BEACHWOOD OH
44122-5907
US

V. Phone/Fax

Practice location:
  • Phone: 216-312-4300
  • Fax:
Mailing address:
  • Phone: 216-312-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BRIAN HARRISON
Title or Position: OWNER
Credential: PHARM D
Phone: 704-258-7076