Organization
ABL CUSTOM COMPOUNDING
Active
Other names
ABL CUSTOM COMPOUNDING
Organization subpart
No
Provider details
NPI number
Authorized official
BLAIR LUNDBERG RPH (OWNER)
(814) 486-2326
Entity
Organization
Contact information
Practice address
34 E 4TH ST, EMPORIUM, PA 15834-1412
(814) 486-2326
(814) 486-1065
Mailing address
PO BOX 384, EMPORIUM, PA 15834-0384
(814) 486-2326
(814) 486-1065
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
PP481743
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2082235
PK
—
Enumeration date
02/27/2007
Last updated
11/04/2014
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