Provider Demographics
NPI:1720337488
Name:THE COMPOUNDING PHARMACY OF AMERICA
Entity Type:Organization
Organization Name:THE COMPOUNDING PHARMACY OF AMERICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:POTEET
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:404-805-3933
Mailing Address - Street 1:6216 HIGHLAND PLACE WAY
Mailing Address - Street 2:SUITE 101A
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-4070
Mailing Address - Country:US
Mailing Address - Phone:888-972-7239
Mailing Address - Fax:888-689-9892
Practice Address - Street 1:6216 HIGHLAND PLACE WAY
Practice Address - Street 2:SUITE 101A
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-4070
Practice Address - Country:US
Practice Address - Phone:888-972-7239
Practice Address - Fax:888-689-9892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-09
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN050463336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy