Provider Demographics
NPI:1174009732
Name:DIRECT COMPOUNDING AND OUTSOURCING
Entity Type:Organization
Organization Name:DIRECT COMPOUNDING AND OUTSOURCING
Other - Org Name:DIRECT COMPOUNDING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GERBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-500-0271
Mailing Address - Street 1:1850 WHITNEY MESA DR STE 180
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-2093
Mailing Address - Country:US
Mailing Address - Phone:702-877-0703
Mailing Address - Fax:
Practice Address - Street 1:1850 WHITNEY MESA DR STE 180
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2093
Practice Address - Country:US
Practice Address - Phone:702-877-0703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy