Provider Demographics
NPI:1700071198
Name:UNIVERSITY COMPOUNDING CENTER LLC
Entity Type:Organization
Organization Name:UNIVERSITY COMPOUNDING CENTER LLC
Other - Org Name:UNIVERISITY COMPOUNDING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:REEVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-337-6368
Mailing Address - Street 1:1429 W SAGINAW ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-3989
Mailing Address - Country:US
Mailing Address - Phone:517-351-6337
Mailing Address - Fax:
Practice Address - Street 1:1429 W SAGINAW ST STE 140
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-3989
Practice Address - Country:US
Practice Address - Phone:517-351-6337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010086413336C0004X
3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2373885OtherNCPDP PROVIDER IDENTIFICATION NUMBER