CUSTOM HEALTH PHARMACY INC (NPI# 1104088020) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104088020 |
| Entity Type | Organization |
| Organization Name | CUSTOM HEALTH PHARMACY INC |
| Other Organization Name | CUSTOM HEALTH PHARMACY, INC |
| Practice Address |
844 Willard Dr Ste 7 Green Bay WI 54304-5265 |
| Practice Telephone | 9208847345 |
| Practice Fax Number | 9208847346 |
| Mailing Telephone | 9208847345 |
| Mailing Fax Number | 9208847346 |
| Enumeration Date | 2008-07-01 |
| Last Update Date | 2016-05-16 |
| Authorized Official Name | JOHN SOWINSKI (PHARMACIST/PRESIDENT) |
| Authorized Official Telephone | 9204823145 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 333600000X | Pharmacy | Suppliers | ||
| Y | 3336C0004X |
Pharmacy Specialization: Compounding Pharmacy |
9354-42 | WI | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2133536 | 01 |
| Other Name | Type Code |
|---|---|
| Custom Health Pharmacy, Inc | Doing Business As Name - Organization |
| Street Address |
844 WILLARD DR STE 7 |
| City | GREEN BAY |
| State | WI |
| Zip Code | 54304-5265 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689196255 | Kristen Ashley Haltom | Registered Nurse | 2979 Allied St Suite C, Green Bay, WI 54304 | 2017-07-14 |
| 1649671421 | Heather Marie Novak | Counselor | 2979 Allied St Unit C, Green Bay, WI 54304 | 2014-09-11 |
| 1356777684 | Nathan Weir | Specialist/Technologist | 1265 Lombardi Avenue, Green Bay, WI 54304 | 2013-09-18 |
| 1922349927 | John W Hartman | Internal Medicine | 916 Willard Dr, Suite 200, Green Bay, WI 54304 | 2013-03-15 |
| 1447551379 | Citralina M Haruo | Community Health Worker | 1110 11th Avenue, Green Bay, WI 54304 | 2010-11-09 |
| 1497061352 | Daniel James Gustin | Pharmacist | 1109 Lombardi Ave, Green Bay, WI 54304 | 2010-08-28 |
| 1316259898 | Karen A Detrick | Occupational Therapy Assistant | 1040 Pilgram Way, Woodside Senior Communities, Green Bay, WI 54304 | 2010-07-13 |
| 1861667362 | Planned Parenthood of Wi, Inc | Non-Pharmacy Dispensing Site | 2605 S. Oneida St. Suite 107, Green Bay, WI 54304 | 2008-04-25 |
| 1891967303 | Kimberley M Welk | Marriage & Family Therapist | 926 Willard Dr Ste 136, Green Bay, WI 54304 | 2008-03-25 |
| 1750563698 | Richard Lawrence Beyer | Hearing Instrument Specialist | 2154 S Ridge Rd, Green Bay, WI 54304 | 2007-12-03 |
| Find all providers in zip 54304 | ||||
| Taxonomy Code | 3336C0004X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Compounding Pharmacy |
| 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. |
| Notes: Sources: NABP Model Practice Act, Appendix C - Good Compounding Practice, USP <795> and <797>, and Pharmacy Compounding Accreditation Board [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821489931 | Midtown Pharmacy Sc | Pharmacy | 7235 W Appleton Ave Ste 101, Milwaukee, WI 53216-1932 | 2015-02-11 |
| 1255766580 | Sanford Care Services, Inc | Pharmacy | 2423 E Clairemont Ave, Eau Claire, WI 54701-6724 | 2013-09-05 |
| 1487997235 | Iv Compound Center of Wisconsin LLC | Pharmacy | 5478 S Westridge Dr, New Berlin, WI 53151-7948 | 2013-03-30 |
| 1396049706 | Ltc Rx Inc | Pharmacy | 13 E Spruce St Ste 102, Chippewa Falls, WI 54729-2579 | 2010-12-28 |
| 1700025707 | Allergychoices Inc | Pharmacy | 2731 National Dr, Onalaska, WI 54650-8784 | 2009-02-13 |
| 1811043870 | Women's International Pharmacy | Pharmacy | 2 Marsh Ct, Madison, WI 53718-8805 | 2007-01-25 |
| 1871679530 | Waukesha Prescription Center Ltd | Pharmacy | 501 S. Grand Ave., Waukesha, WI 53186 | 2006-10-27 |
| 1386756203 | Manitowoc Pharmacies Inc | Pharmacy | 630 Fremont St, Kiel, WI 53042-1321 | 2006-08-31 |
| 1578109161 | Aurora Pharmacy Inc | Pharmacy | 210 S Pine St, Burlington, WI 53105-1914 | 2019-11-19 |
| 1891132999 | Thrive Health Center Pharmacy | Pharmacy | 831 Critter Ct, Suite 300, Onalaska, WI 54650-8674 | 2013-05-29 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.