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General NPI Number Information
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NPI Number | 1174009732
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Entity Type | Organization
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Legal Business Name | DIRECT COMPOUNDING AND OUTSOURCING
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Dates
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Enumeration Date | 07/17/2018
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Last Update Date | 07/17/2018
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Provider Practice Location Address
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Address Line | 1850 WHITNEY MESA DR STE 180
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City | HENDERSON
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State | NV
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Zip | 89014-2093
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Country | US
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Telephone | 702-877-0703
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Fax |
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Provider Business Mailing Address
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Address Line | 1850 WHITNEY MESA DR STE 180
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City | HENDERSON
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State | NV
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Zip | 89014-2093
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Country | US
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Telephone | 702-877-0703
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | ELLIE GERBER
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Credential |
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Telephone | 760-500-0271
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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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