Provider Demographics
NPI:1699070425
Name:LINCOURT COMPOUNDING CENTER
Entity type:Organization
Organization Name:LINCOURT COMPOUNDING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:F
Authorized Official - Last Name:LADSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:727-479-3046
Mailing Address - Street 1:501 S LINCOLN AVE
Mailing Address - Street 2:SUITE 23
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-5945
Mailing Address - Country:US
Mailing Address - Phone:727-479-3046
Mailing Address - Fax:
Practice Address - Street 1:501 S LINCOLN AVE
Practice Address - Street 2:SUITE 23
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-5945
Practice Address - Country:US
Practice Address - Phone:727-479-3046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH244183336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy