Provider Demographics
NPI:1295899078
Name:MONROE COMPOUNDING CENTER
Entity type:Organization
Organization Name:MONROE COMPOUNDING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:BICKING
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:734-243-5656
Mailing Address - Street 1:126 COLE RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-4104
Mailing Address - Country:US
Mailing Address - Phone:734-240-0032
Mailing Address - Fax:734-243-3964
Practice Address - Street 1:126 COLE RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-4104
Practice Address - Country:US
Practice Address - Phone:734-240-0032
Practice Address - Fax:734-243-3964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010072993336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy