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General NPI Number Information
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NPI Number | 1609275668
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Entity Type | Organization
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Legal Business Name | SPELLBOUND LLC
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Dates
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Enumeration Date | 08/15/2014
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Last Update Date | 01/14/2015
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Provider Practice Location Address
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Address Line | 2600 BEE CREEK ROAD SUITE 1
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City | SPICEWOOD
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State | TX
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Zip | 78669-6711
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Country | US
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Telephone | 512-788-2285
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Fax | 512-344-9595
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Provider Business Mailing Address
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Address Line | 2600 BEE CREEK ROAD SUITE 1
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City | SPICEWOOD
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State | TX
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Zip | 78669-6711
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Country | US
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Telephone | 512-788-2285
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Fax | 512-344-9595
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Authorized Official
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Title or Position | OWNER/PHARMACIST IN CHARGE
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Name | JANEEN MARIE COCO
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Credential |
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Telephone | 512-788-2285
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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 | 29343
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License Number State | TX
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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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Taxonomy #3
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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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