Provider Demographics
NPI:1447476999
Name:THE COMPOUNDING PHARMACY
Entity type:Organization
Organization Name:THE COMPOUNDING PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:MIXON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:828-324-4115
Mailing Address - Street 1:750 4TH ST SW
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-3401
Mailing Address - Country:US
Mailing Address - Phone:828-324-4115
Mailing Address - Fax:828-322-7299
Practice Address - Street 1:750 4TH ST SW
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-3401
Practice Address - Country:US
Practice Address - Phone:828-324-4115
Practice Address - Fax:828-322-7299
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEASURED DOSE PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-17
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
183500000X
NC071853336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No3336C0004XSuppliersPharmacyCompounding PharmacyGroup - Multi-Specialty