Provider Demographics
NPI:1497151252
Name:COMPOUNDING PHARMACY OF AMERICA
Entity Type:Organization
Organization Name:COMPOUNDING PHARMACY OF AMERICA
Other - Org Name:CPA, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:POTEET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-963-4160
Mailing Address - Street 1:6216 HIGHLAND PLACE WAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-4070
Mailing Address - Country:US
Mailing Address - Phone:865-963-4160
Mailing Address - Fax:888-689-9892
Practice Address - Street 1:6216 HIGHLAND PLACE WAY STE 201
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-4068
Practice Address - Country:US
Practice Address - Phone:865-963-4160
Practice Address - Fax:888-689-9892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-06
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TN54633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2148644OtherPK