Provider Demographics
NPI:1316558851
Name:BRICK CITY COMPOUNDING LLC
Entity Type:Organization
Organization Name:BRICK CITY COMPOUNDING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSSHAFEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:769-231-1400
Mailing Address - Street 1:159 FOUNTAINS BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-6344
Mailing Address - Country:US
Mailing Address - Phone:769-231-1400
Mailing Address - Fax:601-859-8201
Practice Address - Street 1:159 FOUNTAINS BLVD STE C
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-6344
Practice Address - Country:US
Practice Address - Phone:769-231-1400
Practice Address - Fax:800-958-5257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-10
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy