Vintage Compounding Pharmacy LLC

Primary specialty

Compounding PharmacyTaxonomy code 3336C0004X

Legal business name

VINTAGE COMPOUNDING PHARMACY LLC

Doing business as

Vintage Compounding Pharmacy

Practice address

9821 Montgomery Blvd NE Ste a
Albuquerque, NM 87111-3571

Phone

(505) 620-4352

NPI assigned

Jul 12, 2023

Last updated

Jul 20, 2023By 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

Dr. Mohammad Zamanian

Title

Pharm.D, RPH

Phone

(505) 620-4352

Specialties & licenses 1

Addresses

Other names 1

• Vintage Compounding Pharmacy Doing business as

Locations

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

{
    "created_epoch": "1689120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689811200000",
    "number": "1457030900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9821 MONTGOMERY BLVD NE STE A",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871113571",
            "telephone_number": "505-620-4352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9821 MONTGOMERY BLVD NE STE A",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871113571",
            "telephone_number": "505-620-4352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VINTAGE COMPOUNDING PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-12",
        "last_updated": "2023-07-20",
        "certification_date": "2023-07-20",
        "status": "A",
        "authorized_official_last_name": "ZAMANIAN",
        "authorized_official_first_name": "MOHAMMAD",
        "authorized_official_title_or_position": "PHARM.D, RPH",
        "authorized_official_telephone_number": "505-620-4352",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vintage Compounding Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Compounding Pharmacy in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Compounding Pharmacy in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2023; 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.