Healthcare Provider Details

I. General information

NPI: 1457009979
Provider Name (Legal Business Name): MIXPILL COMPOUNDING PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2022
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 N MAIN ST STE 400
SPRINGBORO OH
45066-9172
US

IV. Provider business mailing address

3139 HIGHLANDS TRL
LEBANON OH
45036-9446
US

V. Phone/Fax

Practice location:
  • Phone: 937-806-3102
  • Fax: 937-550-4415
Mailing address:
  • Phone: 513-218-4891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: AMANDA MAXAM
Title or Position: CO-OWNER/PHARMACIST
Credential: PHARMD
Phone: 513-218-4891