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General NPI Number Information
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NPI Number | 1518610278
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Entity Type | Organization
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Legal Business Name | PARADISE VALLEY COMPOUNDING PHARMACY LLC
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Dates
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Enumeration Date | 02/01/2022
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Last Update Date | 02/01/2022
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Provider Practice Location Address
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Address Line | 5410 N SCOTTSDALE RD STE A400
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City | PARADISE VALLEY
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State | AZ
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Zip | 85253-5963
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Country | US
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Telephone | 623-200-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 5410 N SCOTTSDALE RD STE A400
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City | PARADISE VALLEY
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State | AZ
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Zip | 85253-5963
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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 | PIC
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Name | PATTIYA WATTANANIMITGUL
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Credential |
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Telephone | 623-200-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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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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