Provider Demographics
NPI:1770849424
Name:COMPOUNDER, LLC
Entity Type:Organization
Organization Name:COMPOUNDER, LLC
Other - Org Name:VITASCRIPT PHARMACY & NUTRITION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SHUMAKE
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHARMACY DOCTOR
Authorized Official - Phone:888-248-3266
Mailing Address - Street 1:6345 WOODSIDE CT STE 102
Mailing Address - Street 2:SUITE #102
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-3224
Mailing Address - Country:US
Mailing Address - Phone:410-309-7926
Mailing Address - Fax:410-309-5956
Practice Address - Street 1:6345 WOODSIDE COURT #102
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-3224
Practice Address - Country:US
Practice Address - Phone:410-309-7926
Practice Address - Fax:410-309-5956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-06
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDPW0213333600000X, 3336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy