| NPI | 1013072289 |
|---|---|
| Doing Business As | CUSTOM RX PHARMACY & WELLNESS CONCEPTS |
| Entity Type | Organization |
| Authorized Contact | NICOLAS L BRANAM PIC 316-636-9595 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: KS 210265) |
| Additional Taxonomies | 3336C0004X Pharmacy Compounding Pharmacy |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2022-02-25 |