| Organization Name: | CUSTOM CHEMISTS PHARMACY INC |
| NPI Number: | 1114205333 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DANIEL ZINKOVSKY (SUPERVISING PHARMACIST) |
| Mailing Address: | 127 Spruce St Unit A Cedarhurst |
| State: | NY US |
| Postal Code: | 115161923 |
| Phone Number: | 5163410500 |
| Fax Number: | 5163410501 |
| NPI Enumeration Date: | 07/22/2011 |
| NPI Last Update Date: | 07/22/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3336C0004X |
| License Number: | 030608 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Pharmacy |
| Taxonomy Specialization: | Compounding Pharmacy |
| Taxonomy Definition: | A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner |