| NPI | 1508162454 |
|---|---|
| Doing Business As | CUSTOMEDICA COMPOUNDING CENTER |
| Entity Type | Organization |
| Authorized Contact | SHAH AFSHAR Cheif Pharmacist 208-939-8008 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0004X Pharmacy, Compounding Pharmacy (Licence: ID 1651RP) |
| Additional Taxonomies | 333600000X Pharmacy |
| 3336C0003X Pharmacy, Community/Retail Pharmacy | |
| 3336S0011X Pharmacy, Specialty Pharmacy | |
| Enumeration Date | 2011-02-09 |
| Last Update Date | 2016-08-17 |