Provider Demographics
NPI:1750413407
Name:ACCESS COMPOUNDING AND CONSULTING PHARMACY
Entity type:Organization
Organization Name:ACCESS COMPOUNDING AND CONSULTING PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RETA
Authorized Official - Middle Name:J
Authorized Official - Last Name:STANDEFER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:423-877-3568
Mailing Address - Street 1:4062 HIXSON PIKE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-3110
Mailing Address - Country:US
Mailing Address - Phone:423-877-3568
Mailing Address - Fax:423-877-2111
Practice Address - Street 1:4062 HIXSON PIKE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37415-3110
Practice Address - Country:US
Practice Address - Phone:423-877-3568
Practice Address - Fax:423-877-2111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38063336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy