Provider Demographics
NPI:1184296238
Name:MAGNUM COMPOUNDING, LLC
Entity type:Organization
Organization Name:MAGNUM COMPOUNDING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GHASSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FADDOUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-622-2301
Mailing Address - Street 1:9960 NW 116TH WAY STE 4
Mailing Address - Street 2:
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33178-1174
Mailing Address - Country:US
Mailing Address - Phone:786-622-2301
Mailing Address - Fax:
Practice Address - Street 1:9960 NW 116TH WAY STE 4
Practice Address - Street 2:
Practice Address - City:MEDLEY
Practice Address - State:FL
Practice Address - Zip Code:33178-1174
Practice Address - Country:US
Practice Address - Phone:786-622-2301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-16
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy