INFINITY COMPOUNDING SOLUTIONS LLC

Provider Demographics

• NPI: 1144588278
• Name: INFINITY COMPOUNDING SOLUTIONS LLC
• Entity Type: Organization
• Organization Name: INFINITY COMPOUNDING SOLUTIONS LLC
• Other - Org Name: INFINITY CARE SOLUTIONS
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: GENERAL COUNSEL
• Authorized Official - First Name: DAVID
• Authorized Official - Last Name: FISHER
• Authorized Official - Phone: 888-414-5805
• Mailing Address - Street 1: PO BOX 699
• Mailing Address - City: BENTONVILLE
• Mailing Address - State: AR
• Mailing Address - Zip Code: 72712-0699
• Mailing Address - Country: US
• Mailing Address - Phone: 479-250-1443
• Mailing Address - Fax: 479-268-3478
• Practice Address - Street 1: 1204 SE 28TH ST STE 2
• Practice Address - City: BENTONVILLE
• Practice Address - State: AR
• Practice Address - Zip Code: 72712-3887
• Practice Address - Country: US
• Practice Address - Phone: 479-250-1443
• Practice Address - Fax: 479-268-3478
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2012-04-26
• Last Update Date: 2021-07-30

Provider Licenses

State	License ID	Taxonomies
		333600000X, 3336C0003X, 3336C0004X
AK	PHAO1239	3336C0004X
FL	PH26444	3336C0004X
DC	NRX0000401	3336C0004X
GA	PHNR000283	3336C0004X
CA	NRP1341	3336C0004X
KS	22-13001	3336C0004X
ID	20219MS	3336C0004X
DE	A9-0001185	3336C0004X
KY	AR1717	3336C0004X
HI	PMP-857	3336C0004X
IL	54.018092	3336C0004X
IN	64001357A	3336C0004X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	3336C0004X	Suppliers	Pharmacy	Compounding Pharmacy
Yes	333600000X	Suppliers	Pharmacy
No	3336C0003X	Suppliers	Pharmacy	Community/Retail Pharmacy

Provider Identifiers

State	Identifier ID	ID Type	Issuer
OR	1144588278	Medicaid
SD	1144588278	Medicaid
OH	177094	Medicaid
OK	200675590A	Medicaid
VA	1144588278	Medicaid
IA	158837861	Medicaid
IN	201332360A	Medicaid
WA	2071647	Medicaid
NH	3104939	Medicaid
KY	7100416640	Medicaid
NE	10026562900	Medicaid
MO	1144588278	Medicaid
MD	7580070 00	Medicaid
MT	1144588278	Medicaid
KS	201129980A	Medicaid
	2136279	Other	PK
MN	61049	Medicaid
VT	1031051	Medicaid
WV	1144588278	Medicaid
NJ	568848	Medicaid
SC	7A0677	Medicaid
PA	103209818	Medicaid
NM	06506381	Medicaid
ID	1144588278	Medicaid
NV	1144588278	Medicaid
CO	26120054	Medicaid
MI	1144588278	Medicaid
ME	1144588278	Medicaid
WY	1144588278	Medicaid
AR	196379407	Medicaid
MD	7580070 00	Medicaid
MO	1144588278	Medicaid
AL	1144588278	Medicaid
UT	3000343	Medicaid