CUSTOM RX (NPI# 1457682114) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457682114 |
| Entity Type | Organization |
| Organization Name | CUSTOM RX |
| Other Organization Name | CUSTOM RX PHARMACY |
| Practice Address |
173 W 4th St Kuna ID 83634-2046 |
| Mailing Address |
Po Box 246 Kuna ID 83634-0246 |
| Practice Telephone | 2089224400 |
| Practice Fax Number | 2089224499 |
| Mailing Telephone | 2089224400 |
| Mailing Fax Number | 2089224499 |
| Enumeration Date | 2010-01-20 |
| Last Update Date | 2016-06-17 |
| Authorized Official Name | TRAVIS WALTHALL (PHARMACIST/MANAGER) |
| Authorized Official Telephone | 2086318141 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 3336C0004X |
Pharmacy Specialization: Compounding Pharmacy |
Suppliers | ||
| N | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers | ||
| Y | 333600000X | Pharmacy | 2399RP | ID | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2123536 | 01 |
| Other Name | Type Code |
|---|---|
| Custom Rx Pharmacy | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336569227 | Custom Rx | Pharmacy | 114 Harrison Ave, Lowell, AR 72745-9047 | 2014-04-18 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| New York State Corporations | CUSTOM RX PHARMACY LLC | 102-03a Queens Blvd, Forest Hills, New York 11375 |
| Vermont Business Registrations | CUSTOM RX, LLC | 239 New Boston Road, Middle Granville, NY 12849 |
| Street Address |
173 W 4TH ST |
| City | KUNA |
| State | ID |
| Zip Code | 83634-2046 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144566894 | Travis Walthall | Pharmacist | 173 W 4th St, Kuna, ID 83634-2046 | 2012-12-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780298430 | Alliance Medical Group, LLC | Family Medicine | Kuna Primary Health Medical Group, 1474 N. Meridian Road, Kuna, ID 83634 | 2020-09-01 |
| 1558896506 | Nicholas Tock | Social Worker | 190 W Main Street, Kuna, ID 83634 | 2017-04-27 |
| 1790137073 | Jeremy Walker | Dentist | 1353 N Meridian Rd, Ste 101, Kuna, ID 83634 | 2016-07-11 |
| 1194171678 | Kidspeak LLC | Occupational Therapist | 525b Main St, Kuna, ID 83634 | 2016-05-13 |
| 1447617139 | Matt Jordan | Nurse Practitioner | 13900 South Pleasant Valley Road, Kuna, ID 83634 | 2016-01-26 |
| 1386063980 | Colin Brown | Physician Assistant | 13500 S. Pleasant Valley, Kuna, ID 83634 | 2014-04-10 |
| 1912329806 | Brady Tucker | Pharmacist | 1403 North Meridian Rd, Kuna, ID 83634 | 2014-01-10 |
| 1427489954 | Ridley's Family Markets, Inc | Pharmacy | 1403 N Meridian Rd, Kuna, ID 83634 | 2013-12-10 |
| 1538414354 | William Lincoln Poulson | Nurse Practitioner | 13500 South Pleasant Valley Road, Kuna, ID 83634 | 2012-07-18 |
| 1508036286 | Michelle Marie Montoya | Counselor | 190 W. Main St, Kuna, ID 83634 | 2008-03-10 |
| Find all providers in zip 83634 | ||||
| Taxonomy Code | 333600000X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: added definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760531610 | Z Inc | Pharmacy | 700 E Avalon St, Kuna, ID 83634-2140 | 2007-01-09 |
| 1669460093 | Vic's Family Pharmacy Inc | Pharmacy | 173 E 4th St, Kuna, ID 83634-2103 | 2005-10-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043878598 | Legranderx Pharmacy LLC | Pharmacy | 343 E 4th N Ste 126, Rexburg, ID 83440-6004 | 2019-05-30 |
| 1386202026 | Genoa Healthcare, LLC | Pharmacy | 2705 E 17th St Ste S5, Ammon, ID 83406-6601 | 2019-05-29 |
| 1669935813 | Broulim Supermarkets, LLC | Pharmacy | 301 Aspen Sq, Saint Anthony, ID 83445-1662 | 2019-04-12 |
| 1851894380 | Medicine Man North Pharmacy Inc | Pharmacy | 30585 N Roberts Rd, Hayden, ID 83835 | 2018-03-11 |
| 1881194090 | Doc's Pharmacy2 LLC | Pharmacy | 16438 N Highway 41, Rathdrum, ID 83858-6888 | 2018-02-14 |
| 1508365958 | P. Roman Burk Dpm PC | Pharmacy | 2667 E. Gala Court Suite 125, Meridian, ID 83642 | 2018-02-12 |
| 1053860767 | Gooding Pharmacy Inc | Pharmacy | 120 South Apple, Suite A, Shoshone, ID 83352 | 2016-09-23 |
| 1649644584 | Yokes Foods Inc | Pharmacy | 1501 E Seltice Way, Post Falls, ID 83854-7531 | 2015-11-16 |
| 1629452776 | Shopko Stores Operating Co., LLC | Pharmacy | 429 Michigan Ave, Orofino, ID 83544-0000 | 2015-07-17 |
| 1164811402 | Ashton Memorial, Inc | Pharmacy | 23 S. 8th St., Ashton, ID 83420 | 2015-01-09 |
| 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.