Provider Demographics
NPI:1588931836
Name:PANNICHE COMPOUNDING, LTD CO
Entity type:Organization
Organization Name:PANNICHE COMPOUNDING, LTD CO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:CHASE
Authorized Official - Middle Name:B
Authorized Official - Last Name:HIGGINSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:270-823-2986
Mailing Address - Street 1:PO BOX 701693
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40270-1693
Mailing Address - Country:US
Mailing Address - Phone:502-442-0696
Mailing Address - Fax:502-442-0696
Practice Address - Street 1:5703 PRESTON HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-1305
Practice Address - Country:US
Practice Address - Phone:502-442-0696
Practice Address - Fax:502-442-0696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP07477333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy