Customceutical Compounding, Llc

LBN: Customceutical Compounding, Llc
Customceutical Compounding, Llc is an health care organization with primary practice located at 4611 E Shea Blvd Bldg 3, Ste 180, Phoenix AZ 85028. The organization recently has 2 registered licenses in different health care specialties including Suppliers / Community/Retail Pharmacy, Suppliers / Compounding Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty. Customceutical Compounding, Llc can be contacted via phone (480) 516-0272, or through Burch, James W via phone (480) 516-0272.

Contact Information

Primary practice address
4611 E Shea Blvd Bldg 3, Ste 180 Phoenix AZ 85028
Phone: (480) 516-0272
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Burch, James W
Phone: (480) 516-0272

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Community/Retail Pharmacy 3336C0003X Y005317 Arizona
Suppliers / Compounding Pharmacy 3336C0004X Y005317 Arizona

Profile Details

NPI number 1861782856
LBN Legal business name Customceutical Compounding, Llc
DBA Doing business as
Authorized official Burch, James W
Entity Organization
Organization subpart 1 No
Enumeration date Apr 12th, 2011
Last updated Aug 29th, 2018 - 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 1861782856 NPPES
Arizona MEDICAID 960917

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