Provider Demographics
NPI:1265554562
Name:RS COMPOUNDING LLC
Entity type:Organization
Organization Name:RS COMPOUNDING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RENIER
Authorized Official - Middle Name:
Authorized Official - Last Name:GOBEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-925-8200
Mailing Address - Street 1:12617 RACE TRACK RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-1331
Mailing Address - Country:US
Mailing Address - Phone:813-925-8200
Mailing Address - Fax:813-925-8933
Practice Address - Street 1:12617 RACE TRACK RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1331
Practice Address - Country:US
Practice Address - Phone:813-925-8200
Practice Address - Fax:813-925-8933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X, 3336S0011X
FLPH209813336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2004099OtherPK
1008982OtherNCPDP PROVIDER IDENTIFICATION NUMBER
FL6002620001Medicare NSC