Island Compounding Pharmacy

Primary specialty

Compounding PharmacyTaxonomy code 3336C0004X

License

5301007758 Issued in MI

Legal business name

ISLAND COMPOUNDING PHARMACY

Practice address

24201 Meridian Rd
Suite 1
Grosse Ile, MI 48138-2134

Phone

(734) 307-7671

NPI assigned

Dec 16, 2014

Last updated

Dec 16, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Laura Lile, M.D., R.PH.

Title

Owner

Phone

(734) 307-7671

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1418688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418688000000",
    "number": "1235537770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 419",
            "city": "GROSSE ILE",
            "state": "MI",
            "postal_code": "481380419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24201 MERIDIAN RD",
            "address_2": "SUITE 1",
            "city": "GROSSE ILE",
            "state": "MI",
            "postal_code": "481382134",
            "telephone_number": "734-307-7671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISLAND COMPOUNDING PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-16",
        "last_updated": "2014-12-16",
        "status": "A",
        "authorized_official_last_name": "LILE",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "734-307-7671",
        "authorized_official_credential": "M.D., R.PH."
    },
    "taxonomies": [
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "MI",
            "license": "5301007758",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexander Griffith
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• Beth Ann Hedke, ATC
• Carol Jaafar
• Deborah Joseph
• Joyce K Vaclav DO PC
• Amy L.S. Kapala
• Douglas John Kelley, D.O.

• Compounding Pharmacy in Grosse Ile, MI
• Providers in Grosse Ile, MI by specialty
• Compounding Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 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.