Provider Demographics
NPI:1528028388
Name:PRESCRIPTION COMPOUNDING SPECIALISTS INC
Entity Type:Organization
Organization Name:PRESCRIPTION COMPOUNDING SPECIALISTS INC
Other - Org Name:D/B/A MEDICAL CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:808-487-9988
Mailing Address - Street 1:99-115 AIEA HEIGHTS DR
Mailing Address - Street 2:#301
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-3924
Mailing Address - Country:US
Mailing Address - Phone:808-487-9988
Mailing Address - Fax:808-484-0042
Practice Address - Street 1:99-115 AIEA HEIGHTS DR
Practice Address - Street 2:#205
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3924
Practice Address - Country:US
Practice Address - Phone:808-487-9988
Practice Address - Fax:808-424-0042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPHY-646333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI5632290001Medicare NSC