Provider Demographics
NPI:1386784932
Name:COMPOUND CARE PLUS LLC
Entity type:Organization
Organization Name:COMPOUND CARE PLUS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:B
Authorized Official - Last Name:HAMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:251-418-0010
Mailing Address - Street 1:1410 US HIGHWAY 98
Mailing Address - Street 2:UNIT G
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-5110
Mailing Address - Country:US
Mailing Address - Phone:251-418-0010
Mailing Address - Fax:866-832-2264
Practice Address - Street 1:1410 US HIGHWAY 98
Practice Address - Street 2:UNIT G
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-5110
Practice Address - Country:US
Practice Address - Phone:251-418-0010
Practice Address - Fax:866-832-2264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL112440183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL112440OtherSTATE LICENSE NUMBER
AL0132314OtherNCPDP