Provider Demographics
NPI:1255045118
Name:MUSELY COMPOUNDING PHARMACY EAST LLC
Entity type:Organization
Organization Name:MUSELY COMPOUNDING PHARMACY EAST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-708-1881
Mailing Address - Street 1:305 SHAWNEE NORTH DR STE 600
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6714
Mailing Address - Country:US
Mailing Address - Phone:470-328-3001
Mailing Address - Fax:
Practice Address - Street 1:305 SHAWNEE NORTH DR STE 600
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6714
Practice Address - Country:US
Practice Address - Phone:470-328-3001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRUSPER INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy