Organization Name: | POULSBO COMPOUNDING PHARMACY LLC |
NPI Number: | 1114237633 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BRANDON KNOTT (OWNER) |
Mailing Address: | 325 Ne Hostmark St Poulsbo |
State: | WA US |
Postal Code: | 983706668 |
Phone Number: | 3607792737 |
Fax Number: | 3607794905 |
NPI Enumeration Date: | 10/18/2010 |
NPI Last Update Date: | 02/25/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 3336C0004X |
License Number: | 60264395 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Pharmacy |
Taxonomy Specialization: | Compounding Pharmacy |
Taxonomy Definition: | A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner |