Provider Demographics
NPI:1962940858
Name:YOUR HEALTH COMPOUNDING PHARMACY, LLC
Entity type:Organization
Organization Name:YOUR HEALTH COMPOUNDING PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMILLAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:954-366-6519
Mailing Address - Street 1:1000 E ATLANTIC BLVD
Mailing Address - Street 2:#110
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-7479
Mailing Address - Country:US
Mailing Address - Phone:954-366-6519
Mailing Address - Fax:
Practice Address - Street 1:1000 E ATLANTIC BLVD
Practice Address - Street 2:#110
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-7479
Practice Address - Country:US
Practice Address - Phone:954-366-6519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy