Provider Demographics
NPI:1770023574
Name:NATIONWIDE COMPOUNDING RX LLC
Entity Type:Organization
Organization Name:NATIONWIDE COMPOUNDING RX LLC
Other - Org Name:NATIONWIDE COMPOUNDING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:DR
Authorized Official - First Name:KYNSI
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:480-499-8379
Mailing Address - Street 1:14000 N HAYDEN RD STE 185
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-5561
Mailing Address - Country:US
Mailing Address - Phone:480-499-8379
Mailing Address - Fax:480-699-5341
Practice Address - Street 1:14000 N HAYDEN RD STE 185
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-5561
Practice Address - Country:US
Practice Address - Phone:480-499-8379
Practice Address - Fax:480-699-5341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZY0067653336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy