Customedica Compounding Center

LBN: Customedica Pharmacy Inc
Customedica Compounding Center is an health care organization with primary practice located at 149 W State St Ste 101 , Eagle ID 83616-4911. The organization recently has 4 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy, Suppliers / Compounding Pharmacy, Suppliers / Specialty Pharmacy. Suppliers / Compounding Pharmacy is the primary health care specialty. Customedica Pharmacy Inc can be contacted via phone (208) 939-8008, or through Afshar, Shah via phone (208) 939-8008.

Contact Information

Primary practice address
149 W State St Ste 101 Eagle ID 83616-4911
Phone: (208) 939-8008
Fax: (208) 938-1067
Website:
Map and Directions
Authorized official contact:
Name: Afshar, Shah PHARM.D.
Phone: (208) 939-8008

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Pharmacy 333600000X
Suppliers / Community/Retail Pharmacy 3336C0003X
Suppliers / Compounding Pharmacy 3336C0004X 1651RP Idaho
Suppliers / Specialty Pharmacy 3336S0011X

Profile Details

NPI number 1508162454
LBN Legal business name Customedica Pharmacy Inc
DBA Doing business as Customedica Compounding Center
Authorized official Afshar, Shah PHARM.D.
Entity Organization
Organization subpart 1 No
Enumeration date Feb 9th, 2011
Last updated Aug 17th, 2016 - about 8 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1508162454 NPPES
Other 2128455 PK
MEDICAID 806251800 PK

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