Northbay Family Compounding Pharmacy LLC

Primary specialty

Compounding PharmacyTaxonomy code 3336C0004X

License

PHY50251 Issued in CA

Legal business name

NORTHBAY FAMILY COMPOUNDING PHARMACY LLC

Practice address

690 E Tabor Ave
Suite H
Fairfield, CA 94533-4079

Phone

(707) 421-1117

Fax

(707) 421-1118

NPI assigned

Jun 30, 2010

Organization subpart

No

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

Authorized official

Name

Helen Dangtran

Title

Co-Owner/Pharmacist in Charge

Phone

(707) 421-1117

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• NORTHBAY FAMILY COMPOUNDING PHARMACY LLC Doing business as

Locations

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

{
    "created_epoch": "1277856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277856000000",
    "number": "1942511399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "690 E TABOR AVE",
            "address_2": "SUITE H",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945334079",
            "telephone_number": "707-421-1117",
            "fax_number": "707-421-1118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "690 E TABOR AVE",
            "address_2": "SUITE H",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945334079",
            "telephone_number": "707-421-1117",
            "fax_number": "707-421-1118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHBAY FAMILY COMPOUNDING PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-30",
        "last_updated": "2010-06-30",
        "status": "A",
        "authorized_official_last_name": "DANGTRAN",
        "authorized_official_first_name": "HELEN",
        "authorized_official_title_or_position": "CO-OWNER/PHARMACIST IN CHARGE",
        "authorized_official_telephone_number": "707-421-1117"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "CA",
            "license": "PHY50251",
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "5638222",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NORTHBAY FAMILY COMPOUNDING PHARMACY LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jeanine Elizabeth Nordeen, D.D.S.
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• North Bay Prosthetics and Orthotics LLC
• Northbay Health Advantage
• Northbay Health Foundation
• Northbay Health Medical Foundation
• Northbay Healthcare Group
• Northbay Healthcare Group

• All providers in Fairfield, CA
• Compounding Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2010; 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.