| NPI | 1689714552 |
|---|---|
| Doing Business As | PROFESSIONAL COMPOUNDING OF ROSWELL INC |
| Entity Type | Organization |
| Authorized Contact | CHARLES SHANNON President 575-622-6578 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0004X Pharmacy, Compounding Pharmacy (Licence: NM PH00002305) |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2015-08-31 |