Provider Demographics
NPI:1760431787
Name:SIGNATURE COMPOUNDING L L C
Entity Type:Organization
Organization Name:SIGNATURE COMPOUNDING L L C
Other - Org Name:PHARMACY MATTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:STEIN
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARMACY
Authorized Official - Phone:319-337-8649
Mailing Address - Street 1:3526 DOLPHIN DR SE
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-8202
Mailing Address - Country:US
Mailing Address - Phone:319-337-8649
Mailing Address - Fax:319-337-8659
Practice Address - Street 1:3526 DOLPHIN DR SE
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-8202
Practice Address - Country:US
Practice Address - Phone:319-337-8649
Practice Address - Fax:319-337-8659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IA12783336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2030337OtherPK