Organization
INNOVATIVE COMPOUNDING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHARON WILSON (PHARMACY MANAGER/PHARMACIST)
(336) 447-4803
Entity
Organization
Contact information
Practice address
941 CENTER CREST DR, SUITE D, WHITSETT, NC 27377
(336) 447-4803
(336) 447-4805
Mailing address
941 CENTER CREST DR, SUITE D, WHITSETT, NC 27377
(336) 447-4803
(336) 447-4805
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
10636
NC
Other
Enumeration date
11/30/2010
Last updated
11/30/2010
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