Provider Demographics
NPI:1255704615
Name:HOME TOWN COMPOUNDING SPECIALISTS
Entity type:Organization
Organization Name:HOME TOWN COMPOUNDING SPECIALISTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:LELAND
Authorized Official - Last Name:HERBERT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:252-493-6898
Mailing Address - Street 1:6822 CHARETTE CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-9424
Mailing Address - Country:US
Mailing Address - Phone:252-493-6898
Mailing Address - Fax:888-593-3836
Practice Address - Street 1:6822 CHARETTE CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-9424
Practice Address - Country:US
Practice Address - Phone:252-493-6898
Practice Address - Fax:888-593-3836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-07
Last Update Date:2015-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service