Customedica Pharmacy North End

LBN: Customedica Pharmacy Inc
Customedica Pharmacy North End is an health care organization with primary practice located at 1915 W State St , Boise ID 83702-3966. The organization recently has 2 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy. Suppliers / Pharmacy is the primary health care specialty. Customedica Pharmacy Inc can be contacted via phone (208) 515-2211, or through Afshar, Shah via phone (208) 939-8008.

Contact Information

Primary practice address
1915 W State St Boise ID 83702-3966
Phone: (208) 515-2211
Fax: (208) 515-7989
Website:
Map and Directions
Authorized official contact:
Name: Afshar, Shah
Phone: (208) 939-8008

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Pharmacy 333600000X 43415RP Idaho
Suppliers / Community/Retail Pharmacy 3336C0003X

Profile Details

NPI number 1982159133
LBN Legal business name Customedica Pharmacy Inc
DBA Doing business as Customedica Pharmacy North End
Authorized official Afshar, Shah
Entity Organization
Organization subpart 1 No
Enumeration date Aug 17th, 2016
Last updated Nov 7th, 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 1982159133 NPPES
Other 2163643 PK
MEDICAID 1982159133 PK

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