Provider Demographics
NPI:1073981957
Name:CREATIVE COMPOUNDING CENTER, INC.
Entity Type:Organization
Organization Name:CREATIVE COMPOUNDING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DUFRESNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-724-3301
Mailing Address - Street 1:631 N VAN DYKE RD
Mailing Address - Street 2:
Mailing Address - City:IMLAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48444-1181
Mailing Address - Country:US
Mailing Address - Phone:810-724-3301
Mailing Address - Fax:810-724-3303
Practice Address - Street 1:631 N VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:IMLAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48444-1181
Practice Address - Country:US
Practice Address - Phone:810-724-3301
Practice Address - Fax:810-724-3303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL2229543336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy