Provider Demographics
NPI:1407252380
Name:WEATHERFORD COMPOUNDING
Entity Type:Organization
Organization Name:WEATHERFORD COMPOUNDING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:817-599-7781
Mailing Address - Street 1:2005 FORT WORTH HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-4780
Mailing Address - Country:US
Mailing Address - Phone:817-599-7781
Mailing Address - Fax:
Practice Address - Street 1:2005 FORT WORTH HWY STE 100
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-4780
Practice Address - Country:US
Practice Address - Phone:817-599-7781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX270023336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy