45D2263836 CLIA NUMBER - CUSTOM CARE PHARMACY

Laboratory Demographics

CLIA Number: 45D2263836

Facility Name: CUSTOM CARE PHARMACY

Facility Address:
20320 NORTHWEST FREEWAY #300
HOUSTON, TX
ZIP 77055
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Facility Phone Number: 832 688-9666

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1861935389

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	45D2263836
LAB Type	Pharmacy
Facility Name	CUSTOM CARE PHARMACY
Street	20320 NORTHWEST FREEWAY #300
City	HOUSTON
State	TX
ZIP	77055
Phone	832 688-9666
CertificateType	4
CertificateEffectiveDate	7/6/2022
CertificateExpirationDate	7/5/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024