Provider Demographics
NPI:1568802254
Name:MIX COMPOUNDING, LLC
Entity Type:Organization
Organization Name:MIX COMPOUNDING, LLC
Other - Org Name:MIX COMPOUNDING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:FORSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-229-3775
Mailing Address - Street 1:7110 E MCDONALD DR
Mailing Address - Street 2:SUITE C-1
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-5426
Mailing Address - Country:US
Mailing Address - Phone:888-229-3775
Mailing Address - Fax:602-749-6610
Practice Address - Street 1:7110 E MCDONALD DR
Practice Address - Street 2:SUITE C-1
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85253-5426
Practice Address - Country:US
Practice Address - Phone:888-229-3775
Practice Address - Fax:602-749-6610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZY0056183336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy