Organization
INNOVATIVE COMPOUNDING LLC
Active
Other names
INNOVATIVE COMPOUNDING
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES PHILLIPS RPH (OWNER)
(803) 485-8586
Entity
Organization
Contact information
Practice address
941 CENTER CREST DR, SUITE D, WHITSETT, NC 27377-8001
(336) 447-4533
(336) 447-4810
Mailing address
941 CENTER CREST DR, SUITE D, WHITSETT, NC 27377-8001
(336) 447-4533
(336) 447-4810
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
Primary
11414
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2138672
PK
—
Enumeration date
11/29/2010
Last updated
07/18/2013
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