Organization
ELEMENTS COMPOUNDING PHARMACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PETER PETROV PHARMD (PRESIDENT)
(480) 625-4750
Entity
Organization
Contact information
Practice address
2110 E BASELINE RD, SUITE A5-6, MESA, AZ 85204-6970
(480) 625-4750
Mailing address
2110 E BASELINE RD, SUITE A5-6, MESA, AZ 85204-6970
(480) 625-4750
(480) 625-3054
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
Y005900
AZ
3336C0004X
Compounding Pharmacy
Y005900
AZ
Other
Enumeration date
04/29/2014
Last updated
08/21/2014
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