Provider Demographics
NPI:1942343397
Name:PHARMACY COMPOUNDING VENTURES
Entity Type:Organization
Organization Name:PHARMACY COMPOUNDING VENTURES
Other - Org Name:CUSTOM COMPOUNDING CENTER OF ARKANSAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER.OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:SHINABERY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:501-217-0000
Mailing Address - Street 1:11700 KANIS RD
Mailing Address - Street 2:SUITE1
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3729
Mailing Address - Country:US
Mailing Address - Phone:501-217-0000
Mailing Address - Fax:
Practice Address - Street 1:11700 KANIS RD
Practice Address - Street 2:SUITE1
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3729
Practice Address - Country:US
Practice Address - Phone:501-217-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR7501183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty