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FORT WAYNE CUSTOM RX INC NPI 1841347481


NPI Information

NPI: 1841347481
Provider Name: FORT WAYNE CUSTOM RX, INC

Doing Business As: FORT WAYNE CUSTOM RX

Classification: Pharmacist - 183500000X
Entity Type: Organization
Address:
425 E DUPONT RD
FORT WAYNE, IN
ZIP 46825
Phone: (260) 490-3447
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FORT WAYNE CUSTOM RX, INC is a pharmacist in Fort Wayne, IN. The provider is an individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. FORT WAYNE CUSTOM RX, INC NPI is 1841347481. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Fort Wayne Custom Rx.

The provider's business location address is:

425 E DUPONT RD
FORT WAYNE, IN
ZIP 46825-051
Phone: (260) 490-3447
Fax: (260) 490-3457

The provider's authorized official is Gregory S Russell .
The authorized official title is President and has the following contact phone number (260) 490-3447.

The enumeration date for this NPI number is 1/5/2007 and was last updated on 11/12/2014.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1183500000XPharmacist26015397INDIANAYes

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1201228830AMEDICAIDINDIANA
2IN2083OTHERINDIANAMEDICARE MASS IMMUNIZATION (ROSTER BILLING)
35391700001MEDICARE ID-TYPE UNSPECIFIEDINDIANA

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: 4/28/2024

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