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Organization
COMPOUNDING PHARMACY LLC
Active
Organization
COMPOUNDING PHARMACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WESLEY VERNON ARTHUR WATERS III PHARM.D. (OWNER)
(406) 531-5888
Entity
Organization
Contact information
Practice address
310 BLUFF CITY HWY, BRISTOL, TN 37620-4602
(423) 764-4136
(423) 764-5167
Mailing address
PO BOX 305, DAMASCUS, VA 24236-0305
(406) 531-5888
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
—
—
Other
Enumeration date
06/30/2023
Last updated
06/30/2023
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