Provider Demographics
NPI:1336150994
Name:CHAPEL HILL COMPOUNDING
Entity Type:Organization
Organization Name:CHAPEL HILL COMPOUNDING
Other - Org Name:CHAPEL HILL COMPOUNDING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZOE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEFANADIS
Authorized Official - Suffix:
Authorized Official - Credentials:BSPHARM
Authorized Official - Phone:919-967-8805
Mailing Address - Street 1:109 CONNER DR
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-7039
Mailing Address - Country:US
Mailing Address - Phone:919-967-8805
Mailing Address - Fax:919-967-8205
Practice Address - Street 1:109 CONNER DR STE 1200
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-7041
Practice Address - Country:US
Practice Address - Phone:919-967-8805
Practice Address - Fax:919-967-8205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
NC104563336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2068643OtherPK