Provider Demographics
NPI:1093278236
Name:GOLD COUNTRY COMPOUNDING LLC
Entity Type:Organization
Organization Name:GOLD COUNTRY COMPOUNDING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANELL
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:530-264-6167
Mailing Address - Street 1:11990 HERITAGE OAK PL STE 2C
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-2405
Mailing Address - Country:US
Mailing Address - Phone:530-368-2103
Mailing Address - Fax:
Practice Address - Street 1:11990 HERITAGE OAK PL STE 2C
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-2405
Practice Address - Country:US
Practice Address - Phone:530-368-2103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy