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General NPI Number Information
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NPI Number | 1710867080
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Entity Type | Organization
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Legal Business Name | ULTRA LIFE RX COMPOUNDING LLC
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Dates
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Enumeration Date | 09/05/2025
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Last Update Date | 09/05/2025
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Provider Practice Location Address
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Address Line | 17130 TOWNES RD STE B
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City | FRIENDSWOOD
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State | TX
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Zip | 77546-4175
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Country | US
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Telephone | 832-569-2023
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Fax | 877-580-5129
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Provider Business Mailing Address
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Address Line | 17130 TOWNES RD STE B
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City | FRIENDSWOOD
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State | TX
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Zip | 77546-4175
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Country | US
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Telephone | 832-569-2023
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Fax | 877-580-5129
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Authorized Official
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Title or Position | CEO
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Name | CORINA GUERRERO
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Credential | RPH
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Telephone | 281-846-8320
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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 |
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License Number State |
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