Provider Demographics
NPI:1528605482
Name:COTTONWOOD COMPOUNDING PLLC
Entity Type:Organization
Organization Name:COTTONWOOD COMPOUNDING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WITZENMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:801-712-1934
Mailing Address - Street 1:7050 S HIGHLAND DR STE 110
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84121-3764
Mailing Address - Country:US
Mailing Address - Phone:385-279-4268
Mailing Address - Fax:385-279-4348
Practice Address - Street 1:7050 S HIGHLAND DR STE 110
Practice Address - Street 2:
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84121-3764
Practice Address - Country:US
Practice Address - Phone:385-279-4268
Practice Address - Fax:385-279-4348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-10
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy