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General NPI Number Information
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NPI Number | 1770023574
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Entity Type | Organization
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Legal Business Name | NATIONWIDE COMPOUNDING RX LLC
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Dates
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Enumeration Date | 02/28/2017
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Last Update Date | 02/28/2017
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Provider Practice Location Address
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Address Line | 14000 N HAYDEN RD STE 185
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-5561
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Country | US
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Telephone | 480-499-8379
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Fax | 480-699-5341
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Provider Business Mailing Address
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Address Line | 14000 N HAYDEN RD STE 185
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-5561
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Country | US
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Telephone | 480-499-8379
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Fax | 480-699-5341
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY
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Name | DR. KYNSI LEIGH HAMILTON
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Credential | PHARMD
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Telephone | 480-499-8379
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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 | Y006765
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License Number State | AZ
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