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General NPI Number Information
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NPI Number | 1225470016
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Entity Type | Organization
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Legal Business Name | CLINICAL COMPOUNDING SOLUTIONS
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Dates
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Enumeration Date | 07/23/2013
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Last Update Date | 07/23/2013
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Provider Practice Location Address
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Address Line | 3373 MAYFLOWER LN
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City | SOUTHSIDE
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State | AL
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Zip | 35907-7965
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Country | US
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Telephone | 256-490-7760
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Fax | 256-442-3299
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Provider Business Mailing Address
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Address Line | 3373 MAYFLOWER LN
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City | SOUTHSIDE
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State | AL
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Zip | 35907-7965
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Country | US
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Telephone | 256-490-7760
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Fax | 256-442-3299
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Authorized Official
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Title or Position | OWNER
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Name | DR. DANIEL S BAKER
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Credential | PHARM D
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Telephone | 256-490-7760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 16217
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License Number State | AL
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