Specialty Pharmacy & Compounding

Primary specialty

Specialty PharmacyTaxonomy code 3336S0011X

License

PHRE009616 Issued in GA

Legal business name

SPECIALTY PHARMACY & COMPOUNDING

Practice address

650 Henderson Dr
Suite 508
Cartersville, GA 30120-3744

Phone

(770) 607-3455

Fax

(770) 607-3457

NPI assigned

Nov 9, 2009

Organization subpart

No

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

Authorized official

Name

Kevin Callosoe

Title

Secretary

Phone

(770) 596-6998

Specialties & licenses 3

Addresses

Locations

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

{
    "created_epoch": "1257724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257724800000",
    "number": "1184951337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 HENDERSON DR",
            "address_2": "SUITE 508",
            "city": "CARTERSVILLE",
            "state": "GA",
            "postal_code": "301203744",
            "telephone_number": "770-607-3455",
            "fax_number": "770-607-3457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 HENDERSON DR",
            "address_2": "SUITE 508",
            "city": "CARTERSVILLE",
            "state": "GA",
            "postal_code": "301203744",
            "telephone_number": "770-607-3455",
            "fax_number": "770-607-3457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECIALTY PHARMACY & COMPOUNDING",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-09",
        "last_updated": "2009-11-09",
        "status": "A",
        "authorized_official_last_name": "CALLOSOE",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "770-596-6998"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "GA",
            "license": "PHRE009616",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "PHRE009616",
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": "GA",
            "license": "PHRE009616",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2009; 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.