Customedica Pharmacy INC

NPI #1508162454 in Eagle, Idaho

Provider Information

NPI Number: 1508162454
Entity Type: Organization
Organization Name: Customedica Pharmacy INC
Primary Specialty: Pharmacy - Compounding Pharmacy
Enumeration Date: Feb 9, 2011
Last Updated: Aug 17, 2016

Practice Location

Address: 149 W STATE ST STE 101
City: Eagle
State: Idaho
ZIP Code: 83616-4911
Phone: (208) 939-8008

Authorized Official

Name: SHAH AFSHAR, PHARM.D.
Title: CHEIF PHARMACIST
Phone: (208) 939-8008

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pharmacy	333600000X
Pharmacy - Community/Retail Pharmacy — Community/Retail Pharmacy	3336C0003X
Pharmacy - Specialty Pharmacy — Specialty Pharmacy	3336S0011X
Pharmacy - Compounding Pharmacy — Compounding Pharmacy	3336C0004X	Primary

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