Provider Demographics
NPI:1922575315
Name:THE COMPOUNDING LAB
Entity Type:Organization
Organization Name:THE COMPOUNDING LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:423-328-9333
Mailing Address - Street 1:714 W MARKET ST STE 101
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-5483
Mailing Address - Country:US
Mailing Address - Phone:423-328-9333
Mailing Address - Fax:423-328-9334
Practice Address - Street 1:714 W MARKET ST STE 101
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-5483
Practice Address - Country:US
Practice Address - Phone:423-328-9333
Practice Address - Fax:423-328-9334
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CREEKWOOD HOLDINGS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy