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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

Details

NameValue
NPI1245012145
Enumeration Date2023-10-17
NPI TypeNPI-2 Organization
StatusActive
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
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 333600000X - Pharmacy
No 3336C0002X - Pharmacy - Clinic Pharmacy
No 3336C0003X - Pharmacy - Community/Retail Pharmacy
No 3336M0002X - Pharmacy - Mail Order Pharmacy
Yes 3336C0004X - Pharmacy - Compounding Pharmacy