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General NPI Number Information
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NPI Number | 1386597789
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Entity Type | Organization
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Legal Business Name | LUMINARA COMPOUNDING
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Dates
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Enumeration Date | 02/17/2026
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Last Update Date | 02/17/2026
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Provider Practice Location Address
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Address Line | 21 GREEN ST
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City | WALTHAM
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State | MA
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Zip | 02451-1646
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Country | US
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Telephone | 781-226-6922
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Fax |
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Provider Business Mailing Address
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Address Line | 21 GREEN ST
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City | WALTHAM
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State | MA
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Zip | 02451-1646
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Country | US
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Telephone | 781-226-6922
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Fax |
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Authorized Official
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Title or Position | BILLING
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Name | JASON TRUDEL
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Credential |
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Telephone | 781-966-2700
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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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