Provider Demographics
NPI:1609275668
Name:SPELLBOUND LLC
Entity Type:Organization
Organization Name:SPELLBOUND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:JANEEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:COCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-788-2285
Mailing Address - Street 1:2600 BEE CREEK ROAD SUITE 1
Mailing Address - Street 2:
Mailing Address - City:SPICEWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:78669-6711
Mailing Address - Country:US
Mailing Address - Phone:512-788-2285
Mailing Address - Fax:512-344-9595
Practice Address - Street 1:2600 BEE CREEK ROAD SUITE 1
Practice Address - Street 2:
Practice Address - City:SPICEWOOD
Practice Address - State:TX
Practice Address - Zip Code:78669-6711
Practice Address - Country:US
Practice Address - Phone:512-788-2285
Practice Address - Fax:512-344-9595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-15
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X, 3336C0004X
TX293433336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy