CUSTOM RX PHARMACY
NPI 1457682114
Pharmacy in Kuna, ID

Active since January 20, 2010
173 W 4TH ST, KUNA, ID 83634(208) 922-4400(208) 922-4499 Get Directions Write a Review

NPPES record last updated: June 17, 2016. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Custom Rx Pharmacy NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CUSTOM RX PHARMACY (NPI 1457682114) is a healthcare organization registered as a pharmacy in Kuna, Idaho and active in the NPI registry since January 2010. The organization lists Travis Walthall, Pharmacist/manager, as its authorized official.

NPPES Registry Identity

NPI1457682114
Entity TypeOrganization
Primary Taxonomy333600000X
Legal Business NameCUSTOM RX
Location Address173 W 4TH STKuna, ID 83634-2046
Mailing AddressPo Box 246Kuna, ID 83634-0246 · (208) 922-4400 · Fax (208) 922-4499
Fax(208) 922-4499
Organization SubpartNo
Authorized OfficialTravis WalthallPharmacist/manager · (208) 631-8141
Enumeration DateJanuary 20, 2010
Last NPPES UpdateJune 17, 2016
NPI 1457682114 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

Primary SpecialtyPharmacySuppliers
Taxonomy Code333600000X
License Licensed in ID · 2399RP
Definition

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.

Also ListedPharmacy · Community/Retail PharmacyTaxonomy 3336C0003X
Also ListedPharmacy · Compounding PharmacyTaxonomy 3336C0004X
173 W 4TH ST, Kuna, ID 83634

Other Names 1

Doing Business AsCustom Rx Pharmacy

Other Identifiers 1

Other2123536Pk

Accepted Insurance

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 13D2183315

Custom Rx Pharmacy · Kuna, ID
Expired · May 3, 2026
CLIA Number13D2183315
Laboratory TypePharmacy
Certificate Effective DateMay 4, 2024
Certificate Expiration DateMay 3, 2026
Laboratory DirectorEric B. Schlerf
Laboratory Phone(208) 922-4400
Laboratory LocationCustom Rx Pharmacy173 W 4th Street, Kuna, ID 83634
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Pharmacist
173 W 4TH ST
KUNA, ID 83634
Pharmacist
173 W 4TH ST
KUNA, ID 83634
Pharmacist
173 W 4TH ST
KUNA, ID 83634
Pharmacy (Community/Retail Pharmacy)
173 W 4TH ST
KUNA, ID 83634

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1457682114, enumerated as an "organization" on January 20, 2010.

The provider is located at 173 W 4TH ST KUNA, ID 83634 and the phone number is (208) 922-4400.

Pharmacy with taxonomy code 333600000X.

The provider might be accepting Accepts: Medica, Moda Health Plan, Inc., Medicare and. Please consult your insurance carrier or call the provider to verify.