CUSTOMEDICA PHARMACY INC NPI 1780729988

NPI Information

  • NPI: 1780729988
  • Provider Name: CUSTOMEDICA PHARMACY, INC
  • Classification: Pharmacy - 3336C0003X
  • Specialization: Community/Retail Pharmacy
  • Entity Type: Organization
  • Address: 149 W STATE ST
    SUITE 101
    EAGLE, ID
    ZIP 83616
  • Phone: (208) 939-8008

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NPI Details

CUSTOMEDICA PHARMACY, INC is a community/retail pharmacy pharmacy in Eagle, ID. The provider is 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. CUSTOMEDICA PHARMACY, INC NPI is 1780729988. The provider is registered as an organization entity type.

The provider's business location address is:

149 W STATE ST
SUITE 101
EAGLE, ID
ZIP 83616-959
Phone: (208) 939-8008
Fax: (208) 938-1067

The provider's authorized official is Shah Afshar .
The authorized official title is Owner, Pharmacist and has the following contact phone number (208) 939-8008.

The enumeration date for this NPI number is 2/21/2007 and was last updated on 3/7/2023.

Taxonomy Codes

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:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
13336C0004XPharmacyCompounding Pharmacy1651CPIDAHONo
23336C0003XPharmacyCommunity/Retail Pharmacy1651CPIDAHOYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11651CPOTHERIDAHOSTATE LICENSE #
2806251800MEDICAIDIDAHO

What is NPI?

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: 3/30/2025

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