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CUSTOMEDICA COMPOUNDING CENTER
NPI 1508162454
Pharmacy - Compounding Pharmacy in Eagle, ID

Active since February 09, 2011
149 W STATE ST STE 101, EAGLE, ID 83616(208) 939-8008(208) 938-1067 Get Directions Write a Review

NPPES record last updated: August 17, 2016. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Aug 17, 2016, Feb 25, 2016 (2 updates tracked since 2016).

About Customedica Compounding Center NPPES

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

CUSTOMEDICA COMPOUNDING CENTER (NPI 1508162454) is a healthcare organization registered as a compounding pharmacy in Eagle, Idaho and active in the NPI registry since February 2011. The organization lists Shah Afshar, Cheif Pharmacist, as its authorized official.

NPPES Registry Identity

NPI1508162454
Entity TypeOrganization
Primary Taxonomy3336C0004X
Legal Business NameCUSTOMEDICA PHARMACY INC
Location Address149 W STATE ST STE 101Eagle, ID 83616-4911
Mailing Address149 W State St, Suite 101Eagle, ID 83616-4901 · (208) 939-8008 · Fax (208) 938-1067
Phone(208) 939-8008
Fax(208) 938-1067
Organization SubpartNo
Authorized OfficialShah AfsharCheif Pharmacist · (208) 939-8008
Enumeration DateFebruary 9, 2011
Last NPPES UpdateAugust 17, 20162 updates tracked since enumeration
✔ NPI 1508162454 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyPharmacy · Compounding PharmacySuppliers
Taxonomy Code3336C0004X
License✔ Licensed in ID · 1651RP
Definition
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.
Also ListedPharmacyTaxonomy 333600000X
Also ListedPharmacy · Community/Retail PharmacyTaxonomy 3336C0003X
Also ListedPharmacy · Specialty PharmacyTaxonomy 3336S0011X
149 W STATE ST STE 101, Eagle, ID 83616
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Other Names 1

Doing Business AsCustomedica Compounding Center

Other Identifiers 3

Medicare NSC4509190001
Medicaid806251800ID
Other2128455Pk

Other Providers at the Same Location NPPES 3

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

ALEX WALD
Pharmacist
149 W STATE ST STE 101
EAGLE, ID 83616
Ada County (208) 939-8008
MRS. ALYSSA RENAE ZIBROWSKI PHARM.D.
Pharmacist
149 W STATE ST STE 101
EAGLE, ID 83616
Ada County (208) 939-8008
CUSTOMEDICA PHARMACY INC
Pharmacy (Community/Retail Pharmacy)
149 W STATE ST STE 101
EAGLE, ID 83616
Ada County (208) 939-8008

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Customedica Pharmacy Inc's NPI number?

The NPI number for Customedica Pharmacy Inc is 1508162454. It was assigned to this organization in the NPPES registry on February 9, 2011. The provider is doing business as Customedica Compounding Center.

Where is Customedica Pharmacy Inc located?

Customedica Pharmacy Inc is located at 149 W State St Ste 101, Eagle, ID 83616. The listed phone number is (208) 939-8008.

What is Customedica Pharmacy Inc's specialty?

The primary specialty registered for this NPI is Pharmacy, specializing in Compounding Pharmacy, with taxonomy code 3336C0004X.

When was this NPI record last updated?

The NPPES record for Customedica Pharmacy Inc was last updated on August 17, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.