Provider Demographics
NPI:1518387240
Name:COMPOUNDING CENTERS OF AMERICA
Entity Type:Organization
Organization Name:COMPOUNDING CENTERS OF AMERICA
Other - Org Name:CCA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:SWANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-269-1224
Mailing Address - Street 1:41254 HIGHWAY 195 STE G
Mailing Address - Street 2:
Mailing Address - City:HALEYVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35565-8114
Mailing Address - Country:US
Mailing Address - Phone:205-269-1224
Mailing Address - Fax:
Practice Address - Street 1:41254 HIGHWAY 195 STE G
Practice Address - Street 2:
Practice Address - City:HALEYVILLE
Practice Address - State:AL
Practice Address - Zip Code:35565-8114
Practice Address - Country:US
Practice Address - Phone:205-269-1224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy