Organization
COMPOUNDING CENTERS OF AMERICA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN SWANN (OWNER)
(205) 486-1915
Entity
Organization
Contact information
Practice address
41254 HIGHWAY 195, SUITE G, HALEYVILLE, AL 35565-8114
(205) 486-1915
Mailing address
41254 HIGHWAY 195 STE G, HALEYVILLE, AL 35565-8114
(205) 486-1915
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
114348
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
114348
PHARMACY PERMIT
AL
Enumeration date
05/12/2014
Last updated
05/12/2014
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