Organization
PROFESSIONAL COMPOUNDING OF ROSWELL INC
Active
Other names
PROFESSIONAL COMPOUNDING OF ROSWELL INC
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES SHANNON RPH (PRESIDENT)
(575) 622-6578
Entity
Organization
Contact information
Practice address
700 N UNION AVE, ROSWELL, NM 88201-3956
(575) 622-6578
(575) 623-3801
Mailing address
700 N UNION AVE, ROSWELL, NM 88201-3956
(575) 622-6578
(575) 623-3801
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0004X
Compounding Pharmacy
Primary
PH00002305
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2058933
PK
—
Enumeration date
02/08/2007
Last updated
08/31/2015
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us