Provider Demographics
NPI:1598524290
Name:J & L COMPOUNDING LLC
Entity Type:Organization
Organization Name:J & L COMPOUNDING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:HIBBITTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-508-3267
Mailing Address - Street 1:PO BOX 6295
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29804-6295
Mailing Address - Country:US
Mailing Address - Phone:803-648-7800
Mailing Address - Fax:803-648-7277
Practice Address - Street 1:194 CREPE MYRTLE DR
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-7543
Practice Address - Country:US
Practice Address - Phone:803-648-7800
Practice Address - Fax:803-648-7277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy