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General NPI Number Information
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NPI Number | 1942511399
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Entity Type | Organization
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Legal Business Name | NORTHBAY FAMILY COMPOUNDING PHARMACY LLC
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Dates
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Enumeration Date | 06/30/2010
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Last Update Date | 06/30/2010
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Provider Practice Location Address
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Address Line | 690 E TABOR AVE SUITE H
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City | FAIRFIELD
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State | CA
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Zip | 94533-4079
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Country | US
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Telephone | 707-421-1117
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Fax | 707-421-1118
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Provider Business Mailing Address
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Address Line | 690 E TABOR AVE SUITE H
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City | FAIRFIELD
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State | CA
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Zip | 94533-4079
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Country | US
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Telephone | 707-421-1117
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Fax | 707-421-1118
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Authorized Official
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Title or Position | CO-OWNER/PHARMACIST IN CHARGE
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Name | HELEN DANGTRAN
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Credential |
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Telephone | 707-421-1117
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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 | 3336S0011X
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Taxonomy Name | Specialty 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 | PHY50251
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License Number State | CA
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