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General NPI Number Information
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NPI Number | 1942830922
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Entity Type | Organization
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Legal Business Name | CLASSIC COMPOUNDING PHARMACY, LLC
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Dates
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Enumeration Date | 01/18/2020
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Last Update Date | 01/18/2020
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Provider Practice Location Address
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Address Line | 1171 US ROUTE 1
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City | YORK
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State | ME
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Zip | 03909-5837
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Country | US
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Telephone | 207-351-9010
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Fax | 207-351-9011
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Provider Business Mailing Address
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Address Line | 1171 US ROUTE 1
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City | YORK
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State | ME
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Zip | 03909-5837
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Country | US
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Telephone | 207-351-9010
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Fax | 207-351-9011
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Authorized Official
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Title or Position | MEMBER/PHARMACIST IN CHARGE
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Name | CYNTHIA MARIE THERIAULT
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Credential | RPH
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Telephone | 207-351-9010
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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 |
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License Number State |
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