Provider Demographics
NPI:1700171865
Name:TOWN TOTAL COMPOUNDING CENTERS, LLC
Entity Type:Organization
Organization Name:TOWN TOTAL COMPOUNDING CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:NAVARRA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:516-249-7436
Mailing Address - Street 1:415 CROSSWAYS PARK DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797
Mailing Address - Country:US
Mailing Address - Phone:516-249-7436
Mailing Address - Fax:
Practice Address - Street 1:415 CROSSWAYS PARK DR
Practice Address - Street 2:SUITE B
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797
Practice Address - Country:US
Practice Address - Phone:516-249-7436
Practice Address - Fax:516-249-7437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-16
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030816333600000X
3336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05227743Medicaid
NY030816OtherLICENSE NUMBER