Organization Name: | CUSTOM PHARMACY SERVICES LLC |
NPI Number: | 1588939615 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CHRISTINE SEBASTIANELLI (PRESIDENT) |
Mailing Address: | 517 Main St Duryea |
State: | PA US |
Postal Code: | 186421323 |
Phone Number: | 5702135561 |
Fax Number: | 8886765833 |
NPI Enumeration Date: | 03/22/2012 |
NPI Last Update Date: | 05/29/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 3336C0004X |
License Number: | PP482248 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
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 |