| NPI | 1902252521 |
|---|---|
| Former Legal Business Name | SPECIALTY COMPOUNDING PHARMACY |
| Entity Type | Organization |
| Authorized Contact | KAYLA A PHAM President/CEO 402-304-7564 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: NE 3100) |
| Additional Taxonomies | 3336C0004X Pharmacy Compounding Pharmacy |
| Enumeration Date | 2016-05-12 |
| Last Update Date | 2022-05-10 |