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General NPI Number Information
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NPI Number | 1003603903
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Entity Type | Organization
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Legal Business Name | NORTHERN LIGHTS COMPOUNDING INC.
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Dates
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Enumeration Date | 04/23/2025
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | 1112 S STEPHENSON AVE STE 2
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City | IRON MOUNTAIN
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State | MI
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Zip | 49801-4038
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Country | US
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Telephone | 906-376-0910
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 189
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City | IRON MOUNTAIN
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State | MI
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Zip | 49801-0189
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Country | US
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Telephone | 906-774-1044
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Fax | 906-774-6833
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Authorized Official
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Title or Position | PRESIDENT
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Name | JORDAN MARCHETTI
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Credential | PHARMD
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Telephone | 906-376-0910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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