Organization
SOUTHEASTERN MEDICAL COMPOUNDING LLC
Active
Other names
Southeastern Medical Compounding LLC
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN KENNEDY (VICE PRESIDENT)
(912) 201-8138
Entity
Organization
Contact information
Practice address
709 MALL BLVD RM 356B, SAVANNAH, GA 31406-4805
(912) 201-8138
(877) 329-0079
Mailing address
7370 HODGSON MEMORIAL DR # C5-B, SAVANNAH, GA 31406-2536
(912) 401-3234
(877) 329-0079
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Y006009
AZ
3336C0004X
Compounding Pharmacy
022297550
OH
3336C0004X
Compounding Pharmacy
Primary
114078
AL
3336C0004X
Compounding Pharmacy
2013005924
MO
3336C0004X
Compounding Pharmacy
264044
MN
3336C0004X
Compounding Pharmacy
27038
TX
3336C0004X
Compounding Pharmacy
5301009997
MI
3336C0004X
Compounding Pharmacy
PH25026
FL
3336C0004X
Compounding Pharmacy
PHRE009607
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2140641
PK
—
Enumeration date
01/19/2010
Last updated
06/11/2015
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