Premium Compounding INC
Pharmacy, Compounding Pharmacy in Decatur, AL. Organization (NPI-2).
NPI number1013408772
StatusActive
Last updated in NPPESMay 29, 2018
Details
- NPI
- 1013408772
- Entity type
- Organization (NPI-2)
- Legal business name
- Premium Compounding INC
- Organization subpart
- No
- Enumeration date
- May 29, 2018
- Last updated
- May 29, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 3336C0004X | Pharmacy, Compounding Pharmacy | 114813 | AL | Yes |
Practice location
3220 Highway 31 S Ste A2Decatur, AL 35603-1731
Phone 256-566-8011
Mailing address
3220 Highway 31 S Ste A2Decatur, AL 35603-1731
Phone 256-566-8011
Authorized official
Samuel Marion Costello
President
2565668011
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