Provider Demographics
NPI:1518248376
Name:CNC PHARMACY COMPOUNDING
Entity Type:Organization
Organization Name:CNC PHARMACY COMPOUNDING
Other - Org Name:FAIRFIELD PHARMACY / COMPOUNDING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHIEBONAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ONYEKWELU
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:281-827-4432
Mailing Address - Street 1:15040 FAIRFIELD VILLAGE SQUARE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-7900
Mailing Address - Country:US
Mailing Address - Phone:281-758-4040
Mailing Address - Fax:281-758-4043
Practice Address - Street 1:15040 FAIRFIELD VILLAGE SQUARE DR STE 100
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-7900
Practice Address - Country:US
Practice Address - Phone:281-758-4040
Practice Address - Fax:281-758-4043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-07
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27661333600000X
3336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2132252OtherPK