Provider Demographics
NPI:1750928461
Name:COMPASS PHARMACY LLC
Entity type:Organization
Organization Name:COMPASS PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:719-444-4774
Mailing Address - Street 1:3960 MAIZELAND RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1608
Mailing Address - Country:US
Mailing Address - Phone:719-444-4774
Mailing Address - Fax:719-227-9916
Practice Address - Street 1:3960 MAIZELAND RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1608
Practice Address - Country:US
Practice Address - Phone:719-444-4774
Practice Address - Fax:719-227-9916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility