Healthcare Provider Details

I. General information

NPI: 1972680551
Provider Name (Legal Business Name): HAZLE COMPOUNDING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 NORTH WYOMING ST
HAZLETON PA
18201-6520
US

IV. Provider business mailing address

7 NORTH WYOMING ST
HAZLETON PA
18201-6520
US

V. Phone/Fax

Practice location:
  • Phone: 570-454-2958
  • Fax:
Mailing address:
  • Phone: 570-454-2958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPP481297
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier3982712
Identifier TypeOTHER
Identifier State
Identifier IssuerNAPB

VIII. Authorized Official

Name: MR. WILLIAM L SPEAR
Title or Position: PHARMACIST PRESIDENT
Credential:
Phone: 570-454-2958