Provider Demographics
NPI:1174294516
Name:EPIPHANY COMPOUNDING
Entity Type:Organization
Organization Name:EPIPHANY COMPOUNDING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHISH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-565-2193
Mailing Address - Street 1:10575 N 114TH ST STE 113
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-4908
Mailing Address - Country:US
Mailing Address - Phone:602-767-1221
Mailing Address - Fax:480-781-0016
Practice Address - Street 1:10575 N 114TH ST STE 113
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-4908
Practice Address - Country:US
Practice Address - Phone:602-767-1221
Practice Address - Fax:480-781-0016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy