Elements Compounding Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

Y005900 Issued in AZ

Legal business name

ELEMENTS COMPOUNDING PHARMACY LLC

Practice address

2110 E Baseline Rd
Suite A5-6
Mesa, AZ 85204-6970

Phone

(480) 625-4750

NPI assigned

Apr 29, 2014

Organization subpart

No

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

Authorized official

Name

Peter Petrov, PHARMD

Title

President

Phone

(480) 625-4750

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1398729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1408579200000",
    "number": "1194135103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2110 E BASELINE RD",
            "address_2": "SUITE A5-6",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852046970",
            "telephone_number": "480-625-4750",
            "fax_number": "480-625-3054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2110 E BASELINE RD",
            "address_2": "SUITE A5-6",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852046970",
            "telephone_number": "480-625-4750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELEMENTS COMPOUNDING PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-29",
        "last_updated": "2014-08-21",
        "status": "A",
        "authorized_official_last_name": "PETROV",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "480-625-4750",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AZ",
            "license": "Y005900",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "AZ",
            "license": "Y005900",
            "primary": false
        }
    ],
    "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 Aug 21, 2014; 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.