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General NPI Number Information
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NPI Number | 1720325251
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Entity Type | Organization
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Legal Business Name | COAST TO COAST COMPOUNDING LLC
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Dates
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Enumeration Date | 01/03/2013
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Last Update Date | 01/03/2013
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Provider Practice Location Address
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Address Line | 780 SIMMS ST SUITE 103
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City | GOLDEN
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State | CO
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Zip | 80401-4725
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Country | US
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Telephone | 303-237-4478
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Fax |
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Provider Business Mailing Address
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Address Line | 780 SIMMS ST SUITE 103
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City | GOLDEN
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State | CO
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Zip | 80401-4725
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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 | PHARMACY MANAGER/OWNER
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Name | WENDI SCHMID
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Credential | PHARMD
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Telephone | 303-237-4478
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 1680000020
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License Number State | CO
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