Provider Demographics
NPI:1275646499
Name:TRI-STATE COMPOUNDING PHARMACY LLC
Entity Type:Organization
Organization Name:TRI-STATE COMPOUNDING PHARMACY LLC
Other - Org Name:TRI-STATE COMPOUNDING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER,PIC,AO
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:513-624-7333
Mailing Address - Street 1:7715 BEECHMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45255
Mailing Address - Country:US
Mailing Address - Phone:513-624-7333
Mailing Address - Fax:513-624-7555
Practice Address - Street 1:7715 BEECHMONT AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-4203
Practice Address - Country:US
Practice Address - Phone:513-624-7333
Practice Address - Fax:513-624-7555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OH021356250-033336C0003X
KYOH19343336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2078954OtherPK