Organization
CLINICAL COMPOUNDING PHARMACY
Active
Other names
Great Earth Compounds
Organization subpart
No
Provider details
NPI number
Authorized official
HELEN KIZLER (PRESIDENT/PIC)
(323) 650-0025
Entity
Organization
Contact information
Practice address
8941 SANTA MONICA BLVD, WEST HOLLYWOOD, CA 90069-4912
(323) 650-0025
(323) 650-0029
Mailing address
8941 SANTA MONICA BLVD, WEST HOLLYWOOD, CA 90069-4912
(323) 650-0025
(323) 650-0029
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
50743
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5629110
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
01/22/2008
Last updated
12/01/2011
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