Organization Name: | INTRATHECAL COMPOUNDING SPECIALISTS LLC |
NPI Number: | 1952579484 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | STUART BURGESS (DIR OF PHARMACY) |
Mailing Address: | 206 A Jacobs Run Scott |
State: | LA US |
Postal Code: | 70583 |
Phone Number: | 3372376077 |
Fax Number: | 3372378841 |
NPI Enumeration Date: | 02/19/2008 |
NPI Last Update Date: | 12/09/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 3336C0004X |
License Number: | 5856 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | LA |
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 |