Provider Demographics
NPI:1104062181
Name:QUALITY COMPOUNDING AND SPECIALTY RX LTD
Entity type:Organization
Organization Name:QUALITY COMPOUNDING AND SPECIALTY RX LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SVP OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDERMOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-318-3926
Mailing Address - Street 1:8571 FOXWOOD CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-4313
Mailing Address - Country:US
Mailing Address - Phone:330-318-3926
Mailing Address - Fax:330-318-3927
Practice Address - Street 1:7160 WARREN SHARON RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:OH
Practice Address - Zip Code:44403-9657
Practice Address - Country:US
Practice Address - Phone:330-505-1064
Practice Address - Fax:330-505-1068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-23
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X, 3336S0011X, 333600000X, 3336C0004X
OH0219181003336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2927579Medicaid
2118709OtherPK