Provider Demographics
NPI:1245625821
Name:STERILE COMPOUNDING PHARMACY LLC.
Entity type:Organization
Organization Name:STERILE COMPOUNDING PHARMACY LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:GUSTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-251-3874
Mailing Address - Street 1:7381 114TH AVE
Mailing Address - Street 2:SUITE 405A
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-5131
Mailing Address - Country:US
Mailing Address - Phone:727-474-8381
Mailing Address - Fax:727-623-0935
Practice Address - Street 1:7381 114TH AVE
Practice Address - Street 2:SUITE 405A
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-5131
Practice Address - Country:US
Practice Address - Phone:727-474-8381
Practice Address - Fax:727-623-0935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-01
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH275073336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2151078OtherPK