Organization
STANS COMPOUNDING PHARMACY
Active
Organization
STANS COMPOUNDING PHARMACY
Active
Other names
Stan's Compounding Pharmacy, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
JEFF WOLFENDEN (OWNER)
(423) 775-3030
Entity
Organization
Contact information
Practice address
7787 RHEA COUNTY HWY, DAYTON, TN 37321-5982
(423) 775-3030
(423) 775-6147
Mailing address
PO BOX 309, DAYTON, TN 37321-0309
(423) 775-3030
(423) 775-6147
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0000000556
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2130891
PK
—
Enumeration date
05/17/2011
Last updated
12/13/2016
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