Provider Demographics
NPI:1932540325
Name:PROFESSIONAL COMPOUNDING PHARMACY
Entity Type:Organization
Organization Name:PROFESSIONAL COMPOUNDING PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:N
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-694-5100
Mailing Address - Street 1:721 W WHITTIER BLVD
Mailing Address - Street 2:SUITE H
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-3759
Mailing Address - Country:US
Mailing Address - Phone:562-694-5100
Mailing Address - Fax:562-375-6276
Practice Address - Street 1:721 W WHITTIER BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-3759
Practice Address - Country:US
Practice Address - Phone:562-694-5100
Practice Address - Fax:562-375-6276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA514963336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy