Organization
NORTHBAY FAMILY COMPOUNDING PHARMACY LLC
Active
Other names
NORTHBAY FAMILY COMPOUNDING PHARMACY LLC
Organization subpart
No
Provider details
NPI number
Authorized official
HELEN DANGTRAN (CO-OWNER/PHARMACIST IN CHARGE)
(707) 421-1117
Entity
Organization
Contact information
Practice address
690 E TABOR AVE, SUITE H, FAIRFIELD, CA 94533-4079
(707) 421-1117
(707) 421-1118
Mailing address
690 E TABOR AVE, SUITE H, FAIRFIELD, CA 94533-4079
(707) 421-1117
(707) 421-1118
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0004X
Compounding Pharmacy
Primary
PHY50251
CA
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5638222
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
06/30/2010
Last updated
06/30/2010
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