Healthcare Provider Details

I. General information

NPI: 1821746751
Provider Name (Legal Business Name): PRIMERA COMPOUNDING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2022
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3745 HIGHWAY 6
SUGAR LAND TX
77478-5249
US

IV. Provider business mailing address

30444 SOUTHWEST FWY
ROSENBERG TX
77471-4871
US

V. Phone/Fax

Practice location:
  • Phone: 346-350-5194
  • Fax: 346-321-4500
Mailing address:
  • Phone: 281-202-6136
  • 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

VIII. Authorized Official

Name: BASIL RAAD
Title or Position: PRESIDENT
Credential: RPH
Phone: 281-202-6129