Provider Demographics
NPI:1356583470
Name:PRECISION COMPOUNDING PHARMACY LLC
Entity type:Organization
Organization Name:PRECISION COMPOUNDING PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:VERN
Authorized Official - Middle Name:
Authorized Official - Last Name:OHAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-772-0604
Mailing Address - Street 1:1805 HEMBREE RD
Mailing Address - Street 2:STE C
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-2075
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1805 HEMBREE RD
Practice Address - Street 2:STE C
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-2075
Practice Address - Country:US
Practice Address - Phone:770-772-0604
Practice Address - Fax:770-772-0605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-03
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0095463336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1158624OtherNCPDP PROVIDER IDENTIFICATION NUMBER