| NPI | 1023499985 |
|---|---|
| Doing Business As | CUSTOM COMPOUNDING PHARMACY LLC |
| Entity Type | Organization |
| Authorized Contact | CHARLES BUCHANAN Officer 817-550-6044 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: TX 30028) |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2020-03-30 |