Provider Demographics
NPI:1477864031
Name:P3 COMPOUNDING, LLC
Entity Type:Organization
Organization Name:P3 COMPOUNDING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:865-769-5180
Mailing Address - Street 1:8848 CEDAR SPRINGS LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-5415
Mailing Address - Country:US
Mailing Address - Phone:865-769-5180
Mailing Address - Fax:865-769-5179
Practice Address - Street 1:8848 CEDAR SPRINGS LN
Practice Address - Street 2:SUITE 100
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-5415
Practice Address - Country:US
Practice Address - Phone:865-769-5180
Practice Address - Fax:865-769-5179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4779251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion