Provider Demographics
NPI:1366889685
Name:CENTRAL COMPOUNDING CENTER
Entity type:Organization
Organization Name:CENTRAL COMPOUNDING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:KALADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-938-5545
Mailing Address - Street 1:1306 RTE 33
Mailing Address - Street 2:UNIT #4
Mailing Address - City:FARMINGDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07727-4033
Mailing Address - Country:US
Mailing Address - Phone:732-938-5545
Mailing Address - Fax:
Practice Address - Street 1:1306 RTE 33
Practice Address - Street 2:UNIT #4
Practice Address - City:FARMINGDALE
Practice Address - State:NJ
Practice Address - Zip Code:07727-4033
Practice Address - Country:US
Practice Address - Phone:732-938-5545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS006587003336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy