Provider Demographics
NPI:1972680551
Name:HAZLE COMPOUNDING
Entity Type:Organization
Organization Name:HAZLE COMPOUNDING
Other - Org Name:HAZLE COMPOUNDING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:SPEAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-454-2958
Mailing Address - Street 1:7 NORTH WYOMING ST
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-6520
Mailing Address - Country:US
Mailing Address - Phone:570-454-2958
Mailing Address - Fax:
Practice Address - Street 1:7 NORTH WYOMING ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-6520
Practice Address - Country:US
Practice Address - Phone:570-454-2958
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP481297183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3982712OtherNAPB
BH8549391OtherDEA#