Provider Demographics
NPI:1912255274
Name:CONCIERGE COMPOUNDING PHARMACEUTICALS, INC
Entity Type:Organization
Organization Name:CONCIERGE COMPOUNDING PHARMACEUTICALS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:HOOTAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MELAMED
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:888-367-3092
Mailing Address - Street 1:1887 WHITNEY MESA DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-2069
Mailing Address - Country:US
Mailing Address - Phone:888-367-3092
Mailing Address - Fax:702-463-3111
Practice Address - Street 1:1887 WHITNEY MESA DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2069
Practice Address - Country:US
Practice Address - Phone:888-367-3092
Practice Address - Fax:702-463-3111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPH028533336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy