Healthcare Provider Details

I. General information

NPI: 1104062181
Provider Name (Legal Business Name): QUALITY COMPOUNDING AND SPECIALTY RX LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2008
Last Update Date: 03/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7160 WARREN SHARON RD
BROOKFIELD OH
44403-9657
US

IV. Provider business mailing address

8571 FOXWOOD CT SUITE A
POLAND OH
44514-4313
US

V. Phone/Fax

Practice location:
  • Phone: 330-505-1064
  • Fax: 330-505-1068
Mailing address:
  • Phone: 330-318-3926
  • Fax: 330-318-3927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number021918100
License Number StateOH

VIII. Authorized Official

Name: RONALD MCDERMOTT
Title or Position: SVP OPERATIONS
Credential:
Phone: 330-318-3926