The Compounding Lab

Primary specialty

Compounding PharmacyTaxonomy code 3336C0004X

Legal business name

THE COMPOUNDING LAB

Practice address

714 W Market St Ste 101
Johnson City, TN 37604-5483

Phone

(423) 328-9333

Fax

(423) 328-9334

NPI assigned

Oct 24, 2018

Organization subpart

Yes

Parent organization

CREEKWOOD HOLDINGS INCAs reported in NPPES

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

Authorized official

Name

Josh Harrison, PHARMD

Title

Vice President

Phone

(423) 328-9333

Specialties & licenses 1

Addresses

Other names 1

• THE COMPOUNDING LAB Doing business as

Part of

The Compounding Lab

Locations

Practitioners 1

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

• Jennifer Ann Widener, PHARMD

  • Pharmacist
  • Johnson City, TN
  • NPI 1023839693
  NPD (past)

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

{
    "created_epoch": "1540339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1540339200000",
    "number": "1922575315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "714 W MARKET ST STE 101",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376045483",
            "telephone_number": "423-328-9333",
            "fax_number": "423-328-9334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "714 W MARKET ST STE 101",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376045483",
            "telephone_number": "423-328-9333",
            "fax_number": "423-328-9334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE COMPOUNDING LAB",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CREEKWOOD HOLDINGS INC",
        "enumeration_date": "2018-10-24",
        "last_updated": "2018-10-24",
        "status": "A",
        "authorized_official_last_name": "HARRISON",
        "authorized_official_first_name": "JOSH",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "423-328-9333",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "THE COMPOUNDING LAB",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ryan B. Tewell, PHARMD
• Michael David Thacker, FNP-C
• Aditya Nitin Thakkar, MD
• The Arc of Washington County, Inc
• The Art of Being, PLLC
• The Journey Center for Healing Arts, PLLC
• The Michal Child Development Center
• The Reeves Eye Institute
• The Regional Center for Oral & Maxillofacial Surgery, PC
• The Waters of Johnson City LLC

• All providers in Johnson City, TN
• Compounding Pharmacy in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2018; 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.