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General NPI Number Information
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NPI Number | 1972649598
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Entity Type | Organization
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Legal Business Name | COMPOUND CENTRAL PHARMACY
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 11/04/2021
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Provider Practice Location Address
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Address Line | 5032 KATELLA AVE.
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-2802
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Country | US
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Telephone | 562-431-2308
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Fax | 562-431-7124
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Provider Business Mailing Address
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Address Line | 5032 KATELLA AVE.
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-2802
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Country | US
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Telephone | 562-431-2308
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Fax | 562-431-7124
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Authorized Official
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Title or Position | PIC
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Name | MR. TUAN A NGUYEN
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Credential | RPH
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Telephone | 562-431-2308
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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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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY48388
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License Number State | CA
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