Provider Demographics
NPI:1033301197
Name:AMARILLO COMPOUNDING PHARMACY
Entity Type:Organization
Organization Name:AMARILLO COMPOUNDING PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:DANCE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:806-378-8843
Mailing Address - Street 1:1422 S TYLER ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79101-4237
Mailing Address - Country:US
Mailing Address - Phone:806-378-8843
Mailing Address - Fax:
Practice Address - Street 1:1422 S TYLER ST
Practice Address - Street 2:SUITE 105
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79101-4237
Practice Address - Country:US
Practice Address - Phone:806-378-8843
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX244023336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy