Provider Demographics
NPI:1124423793
Name:CASCADE COMPOUNDING CENTER LLC
Entity type:Organization
Organization Name:CASCADE COMPOUNDING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ERICK
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHEIDERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:541-389-3671
Mailing Address - Street 1:19550 AMBER MEADOW DR STE B
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3525
Mailing Address - Country:US
Mailing Address - Phone:541-389-3671
Mailing Address - Fax:541-728-0988
Practice Address - Street 1:19550 AMBER MEADOW DR
Practice Address - Street 2:SUITE 170
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3525
Practice Address - Country:US
Practice Address - Phone:541-389-3671
Practice Address - Fax:541-728-0988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-25
Last Update Date:2014-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRP-0002988-CS3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy