Provider Demographics
NPI:1275894123
Name:WHEELERS CUSTOM COMPOUNDING INC
Entity Type:Organization
Organization Name:WHEELERS CUSTOM COMPOUNDING INC
Other - Org Name:WHEELER'S CUSTOM COMPOUNDING, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-396-6244
Mailing Address - Street 1:327 ROMANY RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-2403
Mailing Address - Country:US
Mailing Address - Phone:859-554-2716
Mailing Address - Fax:859-554-0513
Practice Address - Street 1:327 ROMANY RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-2403
Practice Address - Country:US
Practice Address - Phone:859-554-2716
Practice Address - Fax:859-554-0513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP075273336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2136364OtherPK