Organization
SUPREME COMPOUNDING LLC
Active
Other names
Supreme Compounding
Organization subpart
No
Provider details
NPI number
Authorized official
SHYAMALA SURADA (PHARMACIST)
(571) 230-2884
Entity
Organization
Contact information
Practice address
7346 ANTOINE DR, HOUSTON, TX 77088-7230
(281) 272-0813
Mailing address
7346 ANTOINE DR, HOUSTON, TX 77088-7230
(281) 272-0813
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
29521
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2148385
PK
—
Enumeration date
10/27/2014
Last updated
10/27/2014
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