Provider Demographics
NPI:1447648084
Name:COMPOUNDCORRECTRX
Entity type:Organization
Organization Name:COMPOUNDCORRECTRX
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:CORA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-971-9662
Mailing Address - Street 1:100 COVEY DR STE 204
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-5603
Mailing Address - Country:US
Mailing Address - Phone:615-567-7810
Mailing Address - Fax:615-567-7807
Practice Address - Street 1:100 COVEY DR STE 204
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-5603
Practice Address - Country:US
Practice Address - Phone:615-567-7810
Practice Address - Fax:615-567-7807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN54773336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2149475OtherPK