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General NPI Number Information
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NPI Number | 1942343397
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Entity Type | Organization
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Legal Business Name | PHARMACY COMPOUNDING VENTURES
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 01/30/2013
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Provider Practice Location Address
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Address Line | 11700 KANIS RD SUITE1
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City | LITTLE ROCK
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State | AR
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Zip | 72211-3729
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Country | US
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Telephone | 501-217-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 11700 KANIS RD SUITE1
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City | LITTLE ROCK
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State | AR
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Zip | 72211-3729
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Country | US
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Telephone | 501-217-0000
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Fax |
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Authorized Official
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Title or Position | MANAGER.OWNER
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Name | MARK WAYNE SHINABERY
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Credential | RPH
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Telephone | 501-217-0000
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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 | AR7501
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License Number State | AR
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