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General NPI Number Information
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NPI Number | 1548846850
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Entity Type | Organization
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Legal Business Name | CLEVELAND COMPOUNDING PHARMACY
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Dates
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Enumeration Date | 03/18/2021
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Last Update Date | 07/23/2021
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Provider Practice Location Address
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Address Line | 5511 STATE RD
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City | PARMA
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State | OH
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Zip | 44134-2251
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Country | US
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Telephone | 216-509-1515
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Fax |
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Provider Business Mailing Address
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Address Line | 309 VILLAGE DR
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City | BROADVIEW HTS
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State | OH
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Zip | 44147-3474
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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 | STATUTORY AGENT
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Name | MARIA PUPILLO
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Credential | PHARMD
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Telephone | 216-352-3985
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number |
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License Number State |
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