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Organization
NORTHBAY FAMILY COMPOUNDING PHARMACY LLC
Active
Organization
NORTHBAY FAMILY COMPOUNDING PHARMACY LLC
Active
Other names
NORTHBAY FAMILY COMPOUNDING PHARMACY LLC
Organization subpart
No
Provider details
NPI number
Authorized official
HELEN DANGTRAN (CO-OWNER/PHARMACIST IN CHARGE)
(707) 421-1117
Entity
Organization
Contact information
Practice address
690 E TABOR AVE, SUITE H, FAIRFIELD, CA 94533-4079
(707) 421-1117
(707) 421-1118
Mailing address
690 E TABOR AVE, SUITE H, FAIRFIELD, CA 94533-4079
(707) 421-1117
(707) 421-1118
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0004X
Compounding Pharmacy
Primary
PHY50251
CA
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5638222
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
06/30/2010
Last updated
06/30/2010
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