Provider Demographics
NPI:1124262563
Name:GJ COMPOUNDING LLC
Entity type:Organization
Organization Name:GJ COMPOUNDING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FRAZER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:970-243-5050
Mailing Address - Street 1:2472 PATTERSON RD.
Mailing Address - Street 2:STE. 12
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505
Mailing Address - Country:US
Mailing Address - Phone:970-243-5050
Mailing Address - Fax:970-243-5110
Practice Address - Street 1:2472 PATTERSON RD.
Practice Address - Street 2:STE. 12
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505
Practice Address - Country:US
Practice Address - Phone:970-243-5050
Practice Address - Fax:970-243-5110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-29
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7633336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0621234OtherNCPDP PROVIDER IDENTIFICATION NUMBER