Provider Demographics
NPI:1538565387
Name:THE COMPOUNDING PHARMACY OF AMERICA, INC
Entity type:Organization
Organization Name:THE COMPOUNDING PHARMACY OF AMERICA, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:POTEET
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:865-243-2488
Mailing Address - Street 1:6216 HIGHLAND PLACE WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-4068
Mailing Address - Country:US
Mailing Address - Phone:865-243-2488
Mailing Address - Fax:
Practice Address - Street 1:6216 HIGHLAND PLACE WAY
Practice Address - Street 2:SUITE 201
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-4070
Practice Address - Country:US
Practice Address - Phone:865-243-2488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN54633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy