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General NPI Number Information
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NPI Number | 1033301197
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Entity Type | Organization
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Legal Business Name | AMARILLO COMPOUNDING PHARMACY
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Dates
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Enumeration Date | 08/13/2007
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Last Update Date | 08/13/2007
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Provider Practice Location Address
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Address Line | 1422 S TYLER ST SUITE 105
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City | AMARILLO
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State | TX
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Zip | 79101-4237
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Country | US
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Telephone | 806-378-8843
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Fax |
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Provider Business Mailing Address
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Address Line | 1422 S TYLER ST SUITE 105
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City | AMARILLO
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State | TX
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Zip | 79101-4237
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Country | US
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Telephone | 806-378-8843
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Fax |
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Authorized Official
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Title or Position | PHARMACIST-IN-CHARGE
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Name | DR. BRENT DANCE
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Credential | PHARMD
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Telephone | 806-378-8843
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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 | 24402
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License Number State | TX
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