=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659184513
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RX COMPOUND PROS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2025
-----------------------------------------------------
Last Update Date | 01/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2140 JUSTIN RD STE 100
-----------------------------------------------------
City | HIGHLAND VILLAGE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75077-7163
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-694-7513
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2140 JUSTIN RD STE 100
-----------------------------------------------------
City | LEWISVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75077-7163
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-694-7513
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF OPERATIONS
-----------------------------------------------------
Name | MADISON MAYES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-542-5724
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336M0002X
-----------------------------------------------------
Taxonomy Name | Mail Order Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0004X
-----------------------------------------------------
Taxonomy Name | Compounding Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------