| NPI | 1992132377 |
|---|---|
| Former Legal Business Name | SOUTHEAST COMPOUNDING PHARMACY |
| Entity Type | Organization |
| Authorized Contact | MICHAEL WALKER Member 480-646-4366 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0004X Pharmacy, Compounding Pharmacy |
| Additional Taxonomies | 333600000X Pharmacy |
| 3336C0003X Pharmacy, Community/Retail Pharmacy | |
| 3336C0004X Pharmacy, Compounding Pharmacy (Licence: FL ph27068) | |
| Enumeration Date | 2013-10-01 |
| Last Update Date | 2024-07-25 |