Provider Demographics
NPI:1679865083
Name:TRIAD COMPOUNDING PHARMACY
Entity Type:Organization
Organization Name:TRIAD COMPOUNDING PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:S
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:562-468-4311
Mailing Address - Street 1:11090 ARTESIA BLVD
Mailing Address - Street 2:SUITE H
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-2545
Mailing Address - Country:US
Mailing Address - Phone:562-468-4311
Mailing Address - Fax:562-468-4314
Practice Address - Street 1:11090 ARTESIA BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-2545
Practice Address - Country:US
Practice Address - Phone:562-468-4311
Practice Address - Fax:562-468-4314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29677183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty