CUSTOMEDICA PHARMACY INC is a compounding pharmacy pharmacy in Eagle, ID. The provider is a pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner's Prescription Drug Order or initiative based on the Practitioner/Patient/Pharmacist relationship in the course of professional practice. A compounding pharmacy utilizes specialized equipment and specially designed facilities necessary to meet the legal and quality requirements of its scope of compounding practice. CUSTOMEDICA PHARMACY INC NPI is 1508162454. The provider is registered as an organization entity type. The provider Is Doing Business As Customedica Compounding Center.
The provider's business location address is:
149 W STATE ST STE 101 EAGLE, ID ZIP 83616-911 Phone: (208) 939-8008 Fax: (208) 938-1067
The provider's authorized official is Shah Afshar . The authorized official title is Cheif Pharmacist and has the following contact phone number (208) 939-8008.
The enumeration date for this NPI number is 2/9/2011 and was last updated on 8/17/2016.
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.
This page was last updated on: 11/21/2025
NPI Synchronization or Removal
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