Provider Demographics
NPI:1992399091
Name:PRECISION CUSTOM COMPOUNDS
Entity Type:Organization
Organization Name:PRECISION CUSTOM COMPOUNDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GAGLIARDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-815-1482
Mailing Address - Street 1:4624 S HOLLADAY BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-7169
Mailing Address - Country:US
Mailing Address - Phone:760-815-1482
Mailing Address - Fax:
Practice Address - Street 1:4624 S HOLLADAY BLVD STE 3
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-7169
Practice Address - Country:US
Practice Address - Phone:760-815-1482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy