Provider Demographics
NPI:1710867080
Name:ULTRA LIFE RX COMPOUNDING LLC
Entity type:Organization
Organization Name:ULTRA LIFE RX COMPOUNDING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CORINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUERRERO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:281-846-8320
Mailing Address - Street 1:17130 TOWNES RD STE B
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-4175
Mailing Address - Country:US
Mailing Address - Phone:832-569-2023
Mailing Address - Fax:877-580-5129
Practice Address - Street 1:17130 TOWNES RD STE B
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-4175
Practice Address - Country:US
Practice Address - Phone:832-569-2023
Practice Address - Fax:877-580-5129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy