Fort Wayne Custom Rx, INC
NPI #1841347481 in Fort Wayne, Indiana
Provider Information
- NPI Number
- 1841347481
- Entity Type
- Organization
- Organization Name
- Fort Wayne Custom Rx, INC
- Primary Specialty
- Pharmacist
- Enumeration Date
- Jan 5, 2007
- Last Updated
- Nov 12, 2014
Practice Location
- Address
- 425 E DUPONT RD
- City
- Fort Wayne
- State
- Indiana
- ZIP Code
- 46825-2051
- Phone
- (260) 490-3447
Authorized Official
- Name
- DR. GREGORY S RUSSELL, PHARM. D
- Title
- PRESIDENT
- Phone
- (260) 490-3447
Specialties & Taxonomy Codes
| Specialty |
|---|
| Pharmacist |
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