CUSTOM RX LLC (NPI# 1477029577) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477029577 |
| Entity Type | Organization |
| Organization Name | CUSTOM RX LLC |
| Practice Address |
112 4th St Melba ID 83641-5197 |
| Mailing Address |
Po Box 246 Kuna ID 83634-0246 |
| Practice Telephone | 2084959809 |
| Mailing Telephone | 2089224400 |
| Mailing Fax Number | 2089224499 |
| Enumeration Date | 2018-10-17 |
| Last Update Date | 2018-10-17 |
| Authorized Official Name | TRAVIS WALTHALL (PIC/MANAGING MEMBER) |
| Authorized Official Telephone | 2089224400 |
| Authorized Official Credential | RPH |
| Is Organization Subpart | Y |
| Parent Organization Name | CUSTOM RX LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers |
| Other Name | Type Code |
|---|---|
| Custom Rx Pharmacy Melba | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922328657 | Custom Rx LLC | Pharmacy | 6519 Nicollet Ave, Ste 201, Richfield, MN 55423-1669 | 2010-06-04 |
| Street Address |
112 4TH ST |
| City | MELBA |
| State | ID |
| Zip Code | 83641-5197 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396249546 | Community Health Clinic Inc. | Clinic/Center | 521 Carrie Rex, Melba, ID 83641 | 2018-03-22 |
| 1740239185 | Dan L Watt | Dentist | 150 2nd Avenue, Melba, ID 83641 | 2006-05-10 |
| 1003877986 | Terry Leonard Lewis | Physician Assistant | 150 2nd Ave, Melba, ID 83641 | 2006-03-30 |
| 1053458547 | County of Canyon School District Class B 136j | Local Education Agency (LEA) | 520 Broadway Ave, Melba, ID 83641 | 2007-01-31 |
| 1578574521 | Community Health Clinics Inc | Clinic/Center | 150 2nd Avenue, Melba, ID 83641 | 2006-08-11 |
| 1467964064 | Shanna Renee Dewey | Doula | 8274 Birmingham Rd, Melba, ID 83641-4210 | 2017-11-04 |
| 1669976957 | Community Health Clinics, Inc | Clinic/Center | 6870 Stokes Ave, Melba, ID 83641-5175 | 2018-03-21 |
| 1891197190 | Danielle H Bradshaw | Counselor | 104 Murphy Rd Ste 100a, Melba, ID 83641-5184 | 2014-09-18 |
| 1508824640 | Suhrei Acevedo-daniels | Family Medicine | 150 2nd St, Melba, ID 83641-5199 | 2006-05-01 |
| 1538673769 | Melissa Myers Smith | Counselor | 150 2nd St, Melba, ID 83641-5199 | 2017-11-27 |
| Find all providers in zip 83641 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| 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: new] |
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| 1043838584 | Costco Wholesale Corporation | Pharmacy | 3403 W Chinden Blvd, Meridian, ID 83646-7151 | 2020-07-10 |
| 1265054324 | Costco Wholesale Corporation | Pharmacy | 2495 E Lincoln Rd, Idaho Falls, ID 83401-2203 | 2020-05-12 |
| 1851923544 | Rocky Mountain Pharmacy, LLC | Pharmacy | 3910 Washington Pkwy Ste A, Idaho Falls, ID 83404-7884 | 2020-02-10 |
| 1013559269 | Timberline Pharmacy | Pharmacy | 4574 N Ten Mile Rd Ste 110, Meridian, ID 83646-6930 | 2019-10-09 |
| 1508420373 | K2red LLC | Pharmacy | 447 N Idaho St, Wendell, ID 83355 | 2019-04-27 |
| 1679039135 | Hollis Family Pharmacy LLC | Pharmacy | 845 S Substation Rd, Emmett, ID 83617 | 2019-02-20 |
| 1598229809 | Clearwater Canyon Pharmacy, LLC | Pharmacy | 13020 Us-12, Orofino, ID 83544 | 2019-01-31 |
| 1861999377 | Bi-mart Corporation | Pharmacy | 11347 W State Street, Star, ID 83669 | 2018-04-11 |
| 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.