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General NPI Number Information
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NPI Number | 1154577138
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Entity Type | Organization
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Legal Business Name | US COMPOUNDING INC.
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Dates
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Enumeration Date | 08/11/2008
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Last Update Date | 08/11/2008
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Provider Practice Location Address
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Address Line | 2515 COLLEGE AVE
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City | CONWAY
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State | AR
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Zip | 72034-6135
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Country | US
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Telephone | 501-327-1222
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Fax | 501-327-2488
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Provider Business Mailing Address
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Address Line | 2515 COLLEGE AVE
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City | CONWAY
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State | AR
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Zip | 72034-6135
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Country | US
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Telephone | 501-327-1222
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Fax | 501-327-2488
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Authorized Official
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Title or Position | PRESIDENT, PHARMACIST-IN-CHARGE
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Name | DR. EDDIE GLOVER
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Credential | P.D.
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Telephone | 501-327-1222
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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 | 20503
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License Number State | AR
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