Organization
CUSTOM COMPOUNDING PHARMACY LLC
Active
Other names
CUSTOM COMPOUNDING PHY LLC
Organization subpart
No
Provider details
NPI number
Authorized official
JOE MUSICK RPH (PHARMACIST)
(423) 629-0353
Entity
Organization
Contact information
Practice address
3816 RINGGOLD RD, CHATTANOOGA, TN 37412-1640
(423) 629-0353
(423) 629-9646
Mailing address
3816 RINGGOLD RD, CHATTANOOGA, TN 37412-1640
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0000003295
TN
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4432061
OTHER ID NUMBER
—
Enumeration date
02/02/2007
Last updated
07/20/2007
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