Provider Demographics
NPI:1902509821
Name:IMPACT COMPOUNDING LLC
Entity Type:Organization
Organization Name:IMPACT COMPOUNDING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAME
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:937-761-2606
Mailing Address - Street 1:1920 DONN DAVIS WAY
Mailing Address - Street 2:
Mailing Address - City:TIPP CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45371-7313
Mailing Address - Country:US
Mailing Address - Phone:937-761-2606
Mailing Address - Fax:937-761-2607
Practice Address - Street 1:1920 DONN DAVIS WAY
Practice Address - Street 2:
Practice Address - City:TIPP CITY
Practice Address - State:OH
Practice Address - Zip Code:45371
Practice Address - Country:US
Practice Address - Phone:937-761-2606
Practice Address - Fax:937-761-2607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-22
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy