Provider Information for 1063534154
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TOWNCREST COMPOUNDING LLC
Organization Subpart: NO
NPI: 1063534154
Last Updated: 2023-09-29
Certification Date: 2023-09-29
Certification Date: 2023-09-29
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1063534154 | ||||||||
| Enumeration Date | 2007-04-06 | ||||||||
| NPI Type | NPI-2 Organization | ||||||||
| Status | Active | ||||||||
| Authorized Official Information | Name: Mr. MICHAEL DEBUBGER RPh PhD Title: Compouding Pharmacist Phone: 3193373536 | ||||||||
| Mailing Address | 2306 MUSCATINE AVE IOWA CITY, IA 52240-6637 United States Phone: 319-337-3526 | Fax:319-337-5271 | ||||||||
| Primary Practice Address | 901 S 1ST AVE IOWA CITY, IA 52245-5211 United States Phone: 319-688-4386 | Fax:319-337-5271 | ||||||||
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