CUSTOM RX INC NPI 1811091879

NPI Information

  • NPI: 1811091879
  • Provider Name: CUSTOM RX INC
  • Classification: Pharmacy - 3336C0004X
  • Specialization: Compounding Pharmacy
  • Entity Type: Organization
  • Doing Business As: CUSTOM RX PHARMACY & WELLNESS CONCEPTS
  • Address: 3510 N RIDGE RD STE 900
    WICHITA, KS
    ZIP 67205
  • Phone: (316) 721-2626

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NPI Details

CUSTOM RX INC is a compounding pharmacy pharmacy in Wichita, KS. 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. CUSTOM RX INC NPI is 1811091879. The provider is registered as an organization entity type.
The provider Is Doing Business As Custom Rx Pharmacy & Wellness Concepts.

The provider's business location address is:

3510 N RIDGE RD STE 900
WICHITA, KS
ZIP 67205-225
Phone: (316) 721-2626
Fax: (316) 721-4823

The provider's authorized official is Nicholas L Branam .
The authorized official title is Pharmacist In Charge and has the following contact phone number (316) 721-2626.

The enumeration date for this NPI number is 9/12/2006 and was last updated on 7/12/2023.

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 PharmacyPH00004390NEW MEXICONo
23336C0004XPharmacyCompounding Pharmacy44645MSIDAHONo
33336C0004XPharmacyCompounding Pharmacy4477IOWANo
43336C0004XPharmacyCompounding Pharmacy054.019573ILLINOISNo
53336C0004XPharmacyCompounding Pharmacy64001361AINDIANANo
63336C0004XPharmacyCompounding PharmacyPH02874NEVADANo
73336C0004XPharmacyCompounding Pharmacy264830MINNESOTANo
83336C0004XPharmacyCompounding PharmacyPHNR000914GEORGIANo
93336C0004XPharmacyCompounding PharmacyPHAR1497NORTH DAKOTANo
103336C0004XPharmacyCompounding Pharmacy209867KANSASNo
113336C0004XPharmacyCompounding PharmacyPH17904FLORIDANo
123336C0004XPharmacyCompounding Pharmacy2012019217MISSOURINo
133336C0004XPharmacyCompounding Pharmacy758NEBRASKANo
143336C0004XPharmacyCompounding Pharmacy13708NORTH CAROLINANo
153336C0004XPharmacyCompounding PharmacyOS02495ARKANSASYes

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
12027079OTHERPK
2100445230CMEDICAIDKANSAS

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: 11/21/2025

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