Provider Demographics
NPI:1215143490
Name:COMPOUND PHARMACEUTICAL TECHNOLOGIES, INC.
Entity type:Organization
Organization Name:COMPOUND PHARMACEUTICAL TECHNOLOGIES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:K
Authorized Official - Last Name:HART
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:251-626-2820
Mailing Address - Street 1:1048 STANTON RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-4294
Mailing Address - Country:US
Mailing Address - Phone:251-626-2820
Mailing Address - Fax:
Practice Address - Street 1:1048 STANTON RD
Practice Address - Street 2:SUITE B
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-4294
Practice Address - Country:US
Practice Address - Phone:251-626-2820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL112942333600000X, 3336C0004X
AL2015423336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy