NPIMap

Organization Active NPI

Creative Compounding Solutions LLC

  • Compounding Pharmacy
  • Fort Wayne, IN
National Provider Identifier
1124170014
Registry record updated Jul 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Compounding PharmacyTaxonomy code 3336C0004X
License
60002334A Issued in IN
Legal business name
CREATIVE COMPOUNDING SOLUTIONS LLC
Practice address
2803 E State Blvd
Fort Wayne, IN 46805-4732
Phone
(260) 483-3169
Fax
(260) 483-3160
NPI assigned
Jan 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Andrew CampbellNPI 1871021246
Title
Owner
Phone
(260) 483-3169

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X
Compounding Pharmacy 3336C0004X 60002334A IN Primary

Addresses

Primary practice location

2803 E State Blvd
Fort Wayne, IN 46805-4732

Mailing address

2803 E State Blvd
Fort Wayne, IN 46805-4732
Phone (260) 483-3169

Other identifiers 1

IdentifierTypeStateIssuer
2169538OtherPK

Other names 1

  • Medicine Chest Doing business as

National Provider Directory

National Provider Directory

Locations

2803 E State Blvd
Fort Wayne, IN 46805
Phone (260) 483-3169

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531958400000",
    "number": "1124170014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2803 E STATE BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468054732",
            "telephone_number": "260-483-3169",
            "fax_number": "260-483-3160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2803 E STATE BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468054732",
            "telephone_number": "260-483-3169",
            "fax_number": "260-483-3160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREATIVE COMPOUNDING SOLUTIONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2018-07-19",
        "status": "A",
        "authorized_official_last_name": "CAMPBELL",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "260-483-3169"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "IN",
            "license": "60002334A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2169538",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medicine Chest",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.