Provider Demographics
NPI:1679847636
Name:SERENITY INFUSION SUITES & COMPOUNDING RX
Entity Type:Organization
Organization Name:SERENITY INFUSION SUITES & COMPOUNDING RX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAJUAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-263-4549
Mailing Address - Street 1:8625 KING GEORGE DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-2215
Mailing Address - Country:US
Mailing Address - Phone:469-263-4549
Mailing Address - Fax:
Practice Address - Street 1:8625 KING GEORGE DR
Practice Address - Street 2:SUITE 300
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-2215
Practice Address - Country:US
Practice Address - Phone:469-263-4549
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty