Provider Demographics
NPI:1710690474
Name:IVY SPECIALTY COMPOUNDING, LLC
Entity Type:Organization
Organization Name:IVY SPECIALTY COMPOUNDING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOBGOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-438-3544
Mailing Address - Street 1:2222 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-2100
Mailing Address - Country:US
Mailing Address - Phone:806-209-5140
Mailing Address - Fax:
Practice Address - Street 1:2222 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-2100
Practice Address - Country:US
Practice Address - Phone:806-209-5140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy