Organization
APOTEKA COMPOUNDING LLC
Active
Other names
COMMUNITY CLINICAL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTIAN KANISKI PHARMD (MANAGING MEMBER)
(480) 969-0600
Entity
Organization
Contact information
Practice address
2045 S VINEYARD STE 133, MESA, AZ 85210-6893
(480) 969-0600
(480) 969-0712
Mailing address
2045 S VINEYARD STE 133, MESA, AZ 85210-6893
(480) 969-0600
(480) 969-0712
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
Primary
Y03824
AZ
3336M0002X
Mail Order Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1991673
PK
—
05
—
837734
—
AZ
Enumeration date
08/10/2006
Last updated
02/10/2022
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