Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 3336C0004X | Pharmacy | Compounding Pharmacy | 16452MS | IDAHO | No |
| 2 | 3336C0004X | Pharmacy | Compounding Pharmacy | 5301008923 | MICHIGAN | No |
| 3 | 3336C0004X | Pharmacy | Compounding Pharmacy | PH27532 | FLORIDA | No |
| 4 | 3336C0004X | Pharmacy | Compounding Pharmacy | FL1446 | KENTUCKY | No |
| 5 | 3336C0004X | Pharmacy | Compounding Pharmacy | NRX1701137 | DISTRICT OF COLUMBIA | No |
| 6 | 3336C0004X | Pharmacy | Compounding Pharmacy | A9-0001042 | DELAWARE | No |
| 7 | 3336C0004X | Pharmacy | Compounding Pharmacy | 3942 | IOWA | No |
| 8 | 3336C0004X | Pharmacy | Compounding Pharmacy | P03052 | MARYLAND | No |
| 9 | 3336C0004X | Pharmacy | Compounding Pharmacy | 64000903A | INDIANA | No |
| 10 | 3336C0004X | Pharmacy | Compounding Pharmacy | 22-02899 | KANSAS | No |
| 11 | 3336C0004X | Pharmacy | Compounding Pharmacy | PHNR 000556 | GEORGIA | No |
| 12 | 3336C0004X | Pharmacy | Compounding Pharmacy | 006292 | LOUISIANA | No |
| 13 | 3336C0004X | Pharmacy | Compounding Pharmacy | 054.016601 | ILLINOIS | No |
| 14 | 3336C0004X | Pharmacy | Compounding Pharmacy | PMP-1330 | HAWAII | No |
| 15 | 3336C0004X | Pharmacy | Compounding Pharmacy | | ALABAMA | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 2013120 | OTHER | | PK |
| 2 | 1028490 | MEDICAID | VERMONT | |
| 3 | 1366416448 | MEDICAID | ILLINOIS | |
| 4 | 02199910 | MEDICAID | FLORIDA | |
| 5 | 1000055714 | MEDICAID | WISCONSIN | |
| 6 | 500707688 | MEDICAID | OREGON | |
| 7 | 2856995 | MEDICAID | OHIO | |
| 8 | 134038 | MEDICAID | ARIZONA | |
| 9 | 1366416448 | MEDICAID | IDAHO | |
| 10 | 200647710A | MEDICAID | OKLAHOMA | |
| 11 | 1366416448 | MEDICAID | UTAH | |
| 12 | 2059467 | MEDICAID | WASHINGTON | |
| 13 | 7100410000 | MEDICAID | KENTUCKY | |
| 14 | 201352590A | MEDICAID | INDIANA | |
| 15 | 1366416448 | MEDICAID | NEW MEXICO | |
| 16 | 105780400 | MEDICAID | MARYLAND | |
| 17 | 226807 | MEDICAID | NEW HAMPSHIRE | |
| 18 | 1366416448 | MEDICAID | MINNESOTA | |
| 19 | 546330 | MEDICAID | NEW JERSEY | |
| 20 | 10026562600 | MEDICAID | NEBRASKA | |
| 21 | 1297530001 | MEDICARE NSC | | |
