Provider Demographics
NPI:1104366392
Name:MAKERS COMPOUNDING PHARMACY
Entity Type:Organization
Organization Name:MAKERS COMPOUNDING PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST- OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:360-757-6677
Mailing Address - Street 1:839 S BURLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-3307
Mailing Address - Country:US
Mailing Address - Phone:360-757-6677
Mailing Address - Fax:
Practice Address - Street 1:839 S BURLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-3307
Practice Address - Country:US
Practice Address - Phone:360-757-6677
Practice Address - Fax:360-757-6888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy