| NPI | 1407235013 |
|---|---|
| Former Legal Business Name | CUSTOM PLUS LONG TERM CARE LLC |
| Entity Type | Organization |
| Authorized Contact | MATTHEW HUTERA Owner 654-214-3762 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy, Long Term Care Pharmacy |
| Enumeration Date | 2015-05-28 |
| Last Update Date | 2020-10-20 |