Provider Demographics
NPI:1528424736
Name:GULF COAST COMPOUNDING PHARMACY
Entity type:Organization
Organization Name:GULF COAST COMPOUNDING PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:832-905-2961
Mailing Address - Street 1:1101 W MAIN ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-2046
Mailing Address - Country:US
Mailing Address - Phone:832-905-2961
Mailing Address - Fax:832-905-3142
Practice Address - Street 1:1101 W MAIN ST
Practice Address - Street 2:SUITE F
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-2046
Practice Address - Country:US
Practice Address - Phone:832-905-2961
Practice Address - Fax:832-905-3142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX302013336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy