Provider Demographics
NPI:1326869728
Name:PROSPER COMPOUNDING PHARMACY LLC
Entity type:Organization
Organization Name:PROSPER COMPOUNDING PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:UZOAMAKA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALONWU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-236-5852
Mailing Address - Street 1:3527 HIGHWAY 6 STE 250
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4523
Mailing Address - Country:US
Mailing Address - Phone:281-302-5454
Mailing Address - Fax:281-302-5583
Practice Address - Street 1:3527 HIGHWAY 6 STE 250A
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4523
Practice Address - Country:US
Practice Address - Phone:281-302-5454
Practice Address - Fax:281-302-5583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-18
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy