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General NPI Number Information
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NPI Number | 1104222629
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Entity Type | Organization
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Legal Business Name | P3 COMPOUNDING PHARMACY LLC
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Dates
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Enumeration Date | 11/11/2014
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Last Update Date | 11/11/2014
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Provider Practice Location Address
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Address Line | 1140 HAMMOND DR K-220
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City | ATLANTA
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State | GA
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Zip | 30328-5338
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Country | US
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Telephone | 404-815-1610
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Fax |
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Provider Business Mailing Address
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Address Line | 1140 HAMMOND DR K-220
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City | ATLANTA
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State | GA
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Zip | 30328-5338
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Country | US
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Telephone | 404-815-1610
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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 | TRISTA TANYA TYNER
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Credential | PHARMD
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Telephone | 843-455-2434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH027610
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License Number State | GA
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