Provider Demographics
NPI:1023499985
Name:CROSS TIMBERS COMPOUNDING LLC
Entity type:Organization
Organization Name:CROSS TIMBERS COMPOUNDING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-550-6044
Mailing Address - Street 1:1880 SANTA FE DRIVE SUITE 200
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-6482
Mailing Address - Country:US
Mailing Address - Phone:817-550-6044
Mailing Address - Fax:682-262-1365
Practice Address - Street 1:1880 SANTA FE DRIVE SUITE 200
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-6482
Practice Address - Country:US
Practice Address - Phone:817-550-6044
Practice Address - Fax:682-262-1365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-16
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX30028333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy