Provider Demographics
NPI:1770822934
Name:BIOCOMPOUND LLC
Entity Type:Organization
Organization Name:BIOCOMPOUND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:KISSIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-528-4118
Mailing Address - Street 1:6515 W CLEARWATER AVE
Mailing Address - Street 2:#302
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-1790
Mailing Address - Country:US
Mailing Address - Phone:509-736-9988
Mailing Address - Fax:509-736-9922
Practice Address - Street 1:6515 W CLEARWATER AVE
Practice Address - Street 2:#302
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-1790
Practice Address - Country:US
Practice Address - Phone:509-736-9988
Practice Address - Fax:509-736-9922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3336C0004X3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy