| Organization Name: | CUSTOM SCRIPT PHARMACY |
| NPI Number: | 1104227602 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JONATHAN BEAVER (RESPIRATORY THERAPIST) |
| Mailing Address: | 3738 Teays Valley Rd Ste C Hurricane |
| State: | WV US |
| Postal Code: | 255269705 |
| Phone Number: | 1304733378 |
| Fax Number: | 1304733139 |
| NPI Enumeration Date: | 09/16/2014 |
| NPI Last Update Date: | 09/16/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BX2000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WV |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Oxygen Equipment & Supplies |
| Taxonomy Definition: | |