CUSTOMEDICA PHARMACY, INC (NPI# 1780729988) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780729988 |
| Entity Type | Organization |
| Organization Name | CUSTOMEDICA PHARMACY, INC |
| Practice Address |
149 W State St Suite 101 Eagle ID 83616-4959 |
| Practice Telephone | 2089398008 |
| Practice Fax Number | 2089381067 |
| Mailing Telephone | 2089398008 |
| Mailing Fax Number | 2089381067 |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2012-02-03 |
| Authorized Official Name | SHAH AFSHAR (OWNER, PHARMACIST) |
| Authorized Official Telephone | 2089398008 |
| Authorized Official Credential | RPH |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 3336C0004X |
Pharmacy Specialization: Compounding Pharmacy |
1651CP | ID | Suppliers |
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
1651CP | ID | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| DEA REG # | BC7630076 | 01 | |
| ID | STATE LICENSE # | 1651CP | 01 |
| ID | 806251800 | 05 |
| Street Address |
149 W STATE ST SUITE 101 |
| City | EAGLE |
| State | ID |
| Zip Code | 83616-4959 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902277536 | Shah Afshar | Pharmacist | 149 W State St, Eagle, ID 83616-4901 | 2015-10-08 |
| 1942624515 | Matthew C Murray | Pharmacist | 149 W State St, Suite 101, Eagle, ID 83616-4901 | 2014-02-18 |
| 1902248461 | Alexandria Hughes | Pharmacist | 149 W State St, Eagle, ID 83616-4901 | 2013-07-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730714049 | Care Medical Housecalls PC | Nurse Practitioner | 2040 E Holgate Ct, Eagle, ID 83616 | 2020-03-06 |
| 1629613823 | Counseling Solutions Center LLC | Marriage & Family Therapist | 2618 East Snocreek, Eagle, ID 83616 | 2019-11-12 |
| 1245726918 | Tracy Lyn Hagadorn | Midwife | 182 State Street, Eagle, ID 83616 | 2018-07-06 |
| 1861922627 | Nicholas A. Stelzner | Counselor | 2419 W. State St. Suite 8, Boise, ID 83616 | 2017-06-14 |
| 1184080210 | Gabriel Guerrero | Dermatology | 323 E Riverside Dr Ste 234, Eagle, ID 83616 | 2016-01-05 |
| 1376940668 | Cecilia Jo Hickam | Dental Hygienist | 1121 E. State Street, Suite - 102-d, Eagle, ID 83616 | 2014-12-02 |
| 1871912634 | Christine E Birch | Psychiatry & Neurology | 1032 S Bridgeway Pl Ste 110, Eagle, ID 83616 | 2014-04-09 |
| 1043552524 | Tori Croshaw | Social Worker | 372 S Eagle Rd Ste 190, Eagle, ID 83616 | 2013-03-21 |
| 1053650010 | Kellie Ann Northam | Nurse Practitioner | 192 West State Street, Eagle, ID 83616 | 2013-02-11 |
| 1437494457 | Mary Beth Roehling | Nurse Practitioner | 2040 E Hologate Ct, Eagle, ID 83616 | 2012-12-03 |
| Find all providers in zip 83616 | ||||
| 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] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295336709 | Family Health Services Pharmacy | Pharmacy | 218 W. Nez Perce, Jerome, ID 83338 | 2020-11-03 |
| 1841806494 | Deblaquiere Enterprises, Inc. | Pharmacy | 86 Tank Rd, Oldtown, ID 83822-5126 | 2020-09-18 |
| 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.