Provider Demographics
NPI:1558531244
Name:A & J COMPOUNDING INC
Entity Type:Organization
Organization Name:A & J COMPOUNDING INC
Other - Org Name:JOHNSON COMPOUNDING & WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:WALCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:781-893-3870
Mailing Address - Street 1:577 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02452
Mailing Address - Country:US
Mailing Address - Phone:781-893-3870
Mailing Address - Fax:781-899-1172
Practice Address - Street 1:577 MAIN ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452-5527
Practice Address - Country:US
Practice Address - Phone:781-893-3870
Practice Address - Fax:781-899-1172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
6132260001Medicare NSC