Prescription Compounding Shoppe

Primary specialty

Compounding PharmacyTaxonomy code 3336C0004X

License

PO6571 Issued in KY

Legal business name

PRESCRIPTION COMPOUNDING SHOPPE

Practice address

327 E Broadway St
Campbellsville, KY 42718-2003

Phone

(270) 465-3784

Fax

(270) 789-3784

NPI assigned

Jun 10, 2008

Organization subpart

No

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

Authorized official

Name

Edward Baise

Title

Pharmacist

Phone

(270) 789-2165

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1213056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213056000000",
    "number": "1679733034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "327 E BROADWAY ST",
            "city": "CAMPBELLSVILLE",
            "state": "KY",
            "postal_code": "427182003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "327 E BROADWAY ST",
            "city": "CAMPBELLSVILLE",
            "state": "KY",
            "postal_code": "427182003",
            "telephone_number": "270-465-3784",
            "fax_number": "270-789-3784"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESCRIPTION COMPOUNDING SHOPPE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-10",
        "last_updated": "2008-06-10",
        "status": "A",
        "authorized_official_last_name": "BAISE",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "270-789-2165"
    },
    "taxonomies": [
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "KY",
            "license": "PO6571",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "1830721",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Compounding Pharmacy in Campbellsville, KY
• Providers in Campbellsville, KY by specialty
• Compounding Pharmacy in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2008; 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.