Organization
PARK COMPOUNDING, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREW BOLL (SECRETARY & CFO)
(858) 704-4040
Entity
Organization
Contact information
Practice address
9257 RESEARCH DR, IRVINE, CA 92618
(844) 446-6979
(949) 551-1950
Mailing address
12264 EL CAMINO REAL STE 350, SAN DIEGO, CA 92130-0001
(858) 704-4040
(858) 345-1745
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY53360
CA
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0522967
NCPDP
CA
Enumeration date
02/16/2007
Last updated
10/01/2018
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