Provider Demographics
NPI:1194810036
Name:HUNTSVILLE COMPOUNDING PHARMACY INC
Entity type:Organization
Organization Name:HUNTSVILLE COMPOUNDING PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLESPIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-425-0123
Mailing Address - Street 1:2121 WHITESBURG DR SE
Mailing Address - Street 2:STE E
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4501
Mailing Address - Country:US
Mailing Address - Phone:256-425-0123
Mailing Address - Fax:256-425-0195
Practice Address - Street 1:2121 WHITESBURG DR SE
Practice Address - Street 2:STE E
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4501
Practice Address - Country:US
Practice Address - Phone:256-425-0123
Practice Address - Fax:256-425-0195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1124343336C0003X
3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0132287OtherNCPDP PROVIDER IDENTIFICATION NUMBER
AL107937Medicaid