Provider Demographics
NPI:1477831253
Name:QCCOMPOUNDINGINC
Entity Type:Organization
Organization Name:QCCOMPOUNDINGINC
Other - Org Name:HUNTERS RIDGE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:785-286-2557
Mailing Address - Street 1:3405 NW HUNTERS RIDGE TER
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66618
Mailing Address - Country:US
Mailing Address - Phone:785-286-2557
Mailing Address - Fax:785-286-2559
Practice Address - Street 1:3405 NW HUNTERS RIDGE TER STE 200
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66618-2510
Practice Address - Country:US
Practice Address - Phone:785-286-2557
Practice Address - Fax:785-286-2559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-28
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
KS2-103543336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200739140AMedicaid
2131299OtherPK