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General NPI Number Information
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NPI Number | 1295097335
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Entity Type | Organization
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Legal Business Name | SERENITY INFUSION SUITES & COMPOUNDING RX SOLUTIONS, LLC.
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Dates
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Enumeration Date | 06/14/2012
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Last Update Date | 07/20/2012
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Provider Practice Location Address
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Address Line | 8625 KING GEORGE DR SUITE 300
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City | DALLAS
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State | TX
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Zip | 75235-2215
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Country | US
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Telephone | 469-263-4549
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Fax |
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Provider Business Mailing Address
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Address Line | 8625 KING GEORGE DR SUITE 300
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City | DALLAS
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State | TX
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Zip | 75235-2215
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MISS CAJUAN M. SIMPSON
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Credential |
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Telephone | 469-263-4549
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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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 | 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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