Provider Demographics
NPI:1225470016
Name:CLINICAL COMPOUNDING SOLUTIONS
Entity Type:Organization
Organization Name:CLINICAL COMPOUNDING SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:256-490-7760
Mailing Address - Street 1:3373 MAYFLOWER LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHSIDE
Mailing Address - State:AL
Mailing Address - Zip Code:35907-7965
Mailing Address - Country:US
Mailing Address - Phone:256-490-7760
Mailing Address - Fax:256-442-3299
Practice Address - Street 1:3373 MAYFLOWER LN
Practice Address - Street 2:
Practice Address - City:SOUTHSIDE
Practice Address - State:AL
Practice Address - Zip Code:35907-7965
Practice Address - Country:US
Practice Address - Phone:256-490-7760
Practice Address - Fax:256-442-3299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16217183500000X
1835P0018X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Multi-Specialty
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapyGroup - Multi-Specialty