# THERACOMPRX LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1598181000
- **Authorized official:** MR. KENNETH WAYNE BAILES II RPH, PHARMD (PHARMACIST-IN-CHARGE/OWNER)
- **Authorized official phone:** (580) 759-6238

## Contact information

- **Practice address:** 1414 ARLINGTON ST, STE 2200, ADA, OK 74820-2646
- **Practice address phone:** (580) 436-9922
- **Practice address fax:** (580) 436-9919
- **Mailing address:** 1414 ARLINGTON ST, STE 2200, ADA, OK 74820-2646
- **Mailing address phone:** (580) 436-9922
- **Mailing address fax:** (580) 436-9919

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0004X | Compounding Pharmacy | 23-6620 | OK | Yes |

## Other

- **Enumeration date:** 03/07/2014
- **Last updated:** 03/07/2014