# COMPOUNDING PHARMACY LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1659058733
- **Authorized official:** WESLEY VERNON ARTHUR WATERS III PHARM.D. (OWNER)
- **Authorized official phone:** (406) 531-5888

## Contact information

- **Practice address:** 310 BLUFF CITY HWY, BRISTOL, TN 37620-4602
- **Practice address phone:** (423) 764-4136
- **Practice address fax:** (423) 764-5167
- **Mailing address:** PO BOX 305, DAMASCUS, VA 24236-0305
- **Mailing address phone:** (406) 531-5888

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | — | Yes |
| 3336C0003X | Community/Retail Pharmacy | — | — | — |
| 3336C0004X | Compounding Pharmacy | — | — | — |

## Other

- **Enumeration date:** 06/30/2023
- **Last updated:** 06/30/2023