Provider Demographics
NPI:1457009979
Name:MIXPILL COMPOUNDING PHARMACY
Entity Type:Organization
Organization Name:MIXPILL COMPOUNDING PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAXAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:513-218-4891
Mailing Address - Street 1:3139 HIGHLANDS TRL
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-9446
Mailing Address - Country:US
Mailing Address - Phone:513-218-4891
Mailing Address - Fax:
Practice Address - Street 1:245 N MAIN ST STE 400
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-9172
Practice Address - Country:US
Practice Address - Phone:937-806-3102
Practice Address - Fax:937-550-4415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy