Provider Demographics
NPI:1457029613
Name:CAROLINA COMPOUND, LLC
Entity Type:Organization
Organization Name:CAROLINA COMPOUND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAYANT
Authorized Official - Middle Name:
Authorized Official - Last Name:JOBANPUTRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-540-4330
Mailing Address - Street 1:7825 BALLANTYNE COMMONS PKWY STE 230
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-3175
Mailing Address - Country:US
Mailing Address - Phone:704-540-4330
Mailing Address - Fax:704-540-4660
Practice Address - Street 1:7825 BALLANTYNE COMMONS PKWY STE 230
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3175
Practice Address - Country:US
Practice Address - Phone:704-540-4330
Practice Address - Fax:704-540-4660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy