Provider Demographics
NPI:1548576317
Name:CREATIVE COMPOUNDS INC
Entity Type:Organization
Organization Name:CREATIVE COMPOUNDS INC
Other - Org Name:HARBOR COMPOUNDING AND HOME HEALTH CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY/PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:CAN
Authorized Official - Last Name:HUA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:949-642-0106
Mailing Address - Street 1:2000 HARBOR BLVD
Mailing Address - Street 2:STE C-100
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-2601
Mailing Address - Country:US
Mailing Address - Phone:949-642-0106
Mailing Address - Fax:949-642-5039
Practice Address - Street 1:2000 HARBOR BLVD
Practice Address - Street 2:STE C-100
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-2601
Practice Address - Country:US
Practice Address - Phone:909-642-0106
Practice Address - Fax:949-642-5039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PHY50397333600000X
CAPHY503973336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY50397OtherRETAIL PHARMACY PERMIT
CAPHY50397OtherRETAIL PHARMACY PERMIT