Organization
SPECIALTY RX COMPOUNDING & WELLNESS LLC
Active
Other names
Specialty RX Compounding & Wellness
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KYLE DOUGLAS TALLEY CPHT (CFO)
(985) 974-6008
Entity
Organization
Contact information
Practice address
1625 HIGHWAY 51 STE J, PONCHATOULA, LA 70454-6594
(985) 320-4186
Mailing address
1625 HIGHWAY 51 STE J, PONCHATOULA, LA 70454-6594
(985) 320-4186
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
Primary
—
—
Other
Enumeration date
04/08/2024
Last updated
04/08/2024
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