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General NPI Number Information
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NPI Number | 1679865083
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Entity Type | Organization
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Legal Business Name | TRIAD COMPOUNDING PHARMACY
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Dates
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Enumeration Date | 05/04/2011
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Last Update Date | 05/04/2011
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Provider Practice Location Address
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Address Line | 11090 ARTESIA BLVD SUITE H
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City | CERRITOS
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State | CA
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Zip | 90703-2545
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Country | US
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Telephone | 562-468-4311
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Fax | 562-468-4314
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Provider Business Mailing Address
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Address Line | 11090 ARTESIA BLVD SUITE H
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City | CERRITOS
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State | CA
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Zip | 90703-2545
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Country | US
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Telephone | 562-468-4311
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Fax | 562-468-4314
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Authorized Official
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Title or Position | MANAGER
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Name | RONALD S. MILLER
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Credential | PHARM.D.
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Telephone | 562-468-4311
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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 | 29677
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License Number State | CA
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