Provider Demographics
NPI:1174786172
Name:COMPOUNDS BY DESIGN PHARMACY LLC
Entity type:Organization
Organization Name:COMPOUNDS BY DESIGN PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRIKSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHRMD
Authorized Official - Phone:509-943-3030
Mailing Address - Street 1:780 SWIFT BLVD
Mailing Address - Street 2:STE 110
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3524
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:780 SWIFT BLVD
Practice Address - Street 2:STE 110
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3524
Practice Address - Country:US
Practice Address - Phone:509-946-3207
Practice Address - Fax:509-943-3010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X
WACF00591893336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4932984OtherOTHER ID NUMBER