Provider Demographics
NPI:1972649598
Name:COMPOUND CENTRAL PHARMACY
Entity Type:Organization
Organization Name:COMPOUND CENTRAL PHARMACY
Other - Org Name:COMPOUNDING CORNER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:MR
Authorized Official - First Name:TUAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:562-431-2308
Mailing Address - Street 1:5032 KATELLA AVE.
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2802
Mailing Address - Country:US
Mailing Address - Phone:562-431-2308
Mailing Address - Fax:562-431-7124
Practice Address - Street 1:5032 KATELLA AVE.
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2802
Practice Address - Country:US
Practice Address - Phone:562-431-2308
Practice Address - Fax:562-431-7124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY483883336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5625201OtherNCPDP PROVIDER IDENTIFICATION NUMBER