Provider Demographics
NPI:1174838635
Name:NW PHARMACEUTICAL COMPOUNDING, INC
Entity type:Organization
Organization Name:NW PHARMACEUTICAL COMPOUNDING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FORREST
Authorized Official - Middle Name:
Authorized Official - Last Name:FENTRESS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:541-431-7377
Mailing Address - Street 1:935 WILLAGILLESPIE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2106
Mailing Address - Country:US
Mailing Address - Phone:541-431-7377
Mailing Address - Fax:541-431-7378
Practice Address - Street 1:935 WILLAGILLESPIE RD
Practice Address - Street 2:SUITE B
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2106
Practice Address - Country:US
Practice Address - Phone:541-431-7377
Practice Address - Fax:541-431-7378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRP0001584CS3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy