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General NPI Number Information
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NPI Number | 1730368762
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Entity Type | Organization
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Legal Business Name | CREATIVE COMPOUNDS LLC
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Dates
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Enumeration Date | 10/26/2007
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Last Update Date | 11/01/2007
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Provider Practice Location Address
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Address Line | 101 S COIT RD STE 363
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City | RICHARDSON
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State | TX
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Zip | 75080-5743
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Country | US
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Telephone | 972-385-8006
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Fax | 972-385-8009
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Provider Business Mailing Address
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Address Line | 101 S COIT RD STE 363
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City | RICHARDSON
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State | TX
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Zip | 75080-5743
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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 | OWNER
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Name | SARA LE BLANE HOVER
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Credential | RPH
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Telephone | 972-385-8006
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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 |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | 21330
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License Number State | TX
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