Custom Rx Pharmacy

LBN: Custom Rx
Custom Rx Pharmacy is an health care organization with primary practice located at 173 W 4Th St , Kuna ID 83634-2046. The organization recently has 3 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy, Suppliers / Compounding Pharmacy. Suppliers / Pharmacy is the primary health care specialty. Custom Rx can be contacted via phone (208) 922-4400, or through Walthall, Travis via phone (208) 631-8141.

Contact Information

Primary practice address
173 W 4Th St Kuna ID 83634-2046
Phone: (208) 922-4400
Fax: (208) 922-4499
Website:
Map and Directions
Authorized official contact:
Name: Walthall, Travis
Phone: (208) 631-8141

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Pharmacy 333600000X 2399RP Idaho
Suppliers / Community/Retail Pharmacy 3336C0003X
Suppliers / Compounding Pharmacy 3336C0004X

Profile Details

NPI number 1457682114
LBN Legal business name Custom Rx
DBA Doing business as Custom Rx Pharmacy
Authorized official Walthall, Travis
Entity Organization
Organization subpart 1 No
Enumeration date Jan 20th, 2010
Last updated Jun 17th, 2016 - about 10 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 1457682114 NPPES
Other 2123536 PK

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