Customedica Pharmacy, Inc
LBN: Customedica Pharmacy, Inc
Customedica Pharmacy, Inc is an health care organization with primary practice located at 149 W State St Suite 101, Eagle ID 83616-4959. 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.
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 Suite 101
Eagle ID 83616-4959
Phone: (208) 939-8008
Fax: (208) 938-1067
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Suppliers / Community/Retail Pharmacy | 3336C0003X | 1651CP | Idaho |
| Suppliers / Compounding Pharmacy | 3336C0004X | 1651CP | Idaho |
Profile Details
| NPI number | 1780729988 |
|---|---|
| LBN Legal business name | Customedica Pharmacy, Inc |
| DBA Doing business as | |
| Authorized official | Afshar, Shah RPH |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Feb 21st, 2007 |
| Last updated | Mar 7th, 2023 - about 3 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1780729988 | NPPES |
| Idaho | Other | 1651CP | STATE LICENSE # |
| Idaho | MEDICAID | 806251800 | STATE LICENSE # |
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