| NPI | 1699197459 |
|---|---|
| Former Legal Business Name | COMMUNITY COMPOUNDING SPECIALTY PHARMACY |
| Entity Type | Organization |
| Authorized Contact | LAUREN BRADEN Pharmacist In Charge 503-303-7111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0004X Pharmacy, Compounding Pharmacy |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Enumeration Date | 2014-01-14 |
| Last Update Date | 2022-06-14 |