Compounding Pharmacy LLC

Primary specialty

PharmacyTaxonomy code 333600000X

Legal business name

COMPOUNDING PHARMACY LLC

Practice address

310 Bluff City Hwy
Bristol, TN 37620-4602

Phone

(423) 764-4136

Fax

(423) 764-5167

NPI assigned

Jun 30, 2023

Organization subpart

No

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

Authorized official

Name

Wesley Vernon Arthur Waters III, PHARM.D.NPI 1083788343

Title

Owner

Phone

(406) 531-5888

Specialties & licenses 3

Addresses

Tax ID family

Anderson Compounding Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Compounding Pharmacy LLC

  dba Anderson Compounding Pharmacy

  • Community/Retail Pharmacy
  • Bristol, TN
  • NPI 1760437347
  NPD tax ID

Practitioners 1

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

• Wesley V Waters III, PHARM.D., RPH

  • Pharmacist
  • Pittsboro, NC
  • NPI 1083788343
  NPD Authorized official

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

{
    "created_epoch": "1688083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688083200000",
    "number": "1659058733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 305",
            "city": "DAMASCUS",
            "state": "VA",
            "postal_code": "242360305",
            "telephone_number": "406-531-5888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 BLUFF CITY HWY",
            "city": "BRISTOL",
            "state": "TN",
            "postal_code": "376204602",
            "telephone_number": "423-764-4136",
            "fax_number": "423-764-5167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPOUNDING PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-30",
        "last_updated": "2023-06-30",
        "certification_date": "2023-06-30",
        "status": "A",
        "authorized_official_last_name": "WATERS",
        "authorized_official_first_name": "WESLEY",
        "authorized_official_middle_name": "VERNON ARTHUR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "406-531-5888",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "PHARM.D."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittney Lynn Collins, FNP-C
• Cecil Eugene Collins Jr., D.C.
• John Wayne Collins, DO
• Sidney W Collins Jr., MD
• Courtney C Colobro
• Compounding Pharmacy LLC (Anderson Compounding Pharmacy)
• Cassondra Nichole Compton, CRNA
• Jacob Compton, M.D.
• Jenifer C Conerly, NP
• Kimberly Conley, OTRL

• Pharmacy in Bristol, TN
• Providers in Bristol, TN by specialty
• Pharmacy in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 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.