Provider Demographics
NPI:1245875046
Name:CHATTANOOGA COMPOUNDING PHARMACY INC.
Entity type:Organization
Organization Name:CHATTANOOGA COMPOUNDING PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:RAYMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-899-3278
Mailing Address - Street 1:7032 EAST BRAINERD RD
Mailing Address - Street 2:SUITE A-B
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421
Mailing Address - Country:US
Mailing Address - Phone:423-899-3278
Mailing Address - Fax:423-648-0774
Practice Address - Street 1:7032 EAST BRAINERD RD
Practice Address - Street 2:SUITE A-B
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421
Practice Address - Country:US
Practice Address - Phone:423-899-3278
Practice Address - Fax:423-648-0774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-15
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy