Provider Demographics
NPI:1922116193
Name:RAINSVILLE COMPOUNDING PHARMACY, LLC
Entity Type:Organization
Organization Name:RAINSVILLE COMPOUNDING PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:WADE
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:256-638-2255
Mailing Address - Street 1:PO BOX 1370
Mailing Address - Street 2:515 MAIN STREET
Mailing Address - City:RAINSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35986-1370
Mailing Address - Country:US
Mailing Address - Phone:256-638-2255
Mailing Address - Fax:256-638-2257
Practice Address - Street 1:515 MAIN STREET
Practice Address - Street 2:
Practice Address - City:RAINSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35986
Practice Address - Country:US
Practice Address - Phone:256-638-2255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0131526183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty