Provider Information for 1245012145
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LIFESTYLE COMPOUNDING
Organization Subpart: NO
NPI: 1245012145
Last Updated: 2023-10-17
Certification Date: 2023-10-17
Certification Date: 2023-10-17
Details
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NPI | 1245012145 | ||||||||||||||||||||||||
Enumeration Date | 2023-10-17 | ||||||||||||||||||||||||
NPI Type | NPI-2 Organization | ||||||||||||||||||||||||
Status | Active | ||||||||||||||||||||||||
Authorized Official Information | Name: Dr. DUSTON K COMPTON PharmD Title: CEO Phone: 5056095433 | ||||||||||||||||||||||||
Mailing Address | 3840 COMMONS AVE NE STE A ALBUQUERQUE, NM 87109-5831 United States Phone: 505-609-5433 | Fax:505-405-1497 | ||||||||||||||||||||||||
Primary Practice Address | 3840 COMMONS AVE NE STE A ALBUQUERQUE, NM 87109-5831 United States Phone: 505-609-5433 | Fax:505-405-1497 | ||||||||||||||||||||||||
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