| NPI | 1841347481 |
|---|---|
| Doing Business As | FORT WAYNE CUSTOM RX |
| Entity Type | Organization |
| Authorized Contact | GREGORY S RUSSELL President 260-490-3447 |
| Organization Subpart ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: IN 26015397) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2014-11-12 |