Custom RX Compounding Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

261509-5 Issued in MN

Legal business name

CUSTOM RX COMPOUNDING PHARMACY

Practice address

6519 Nicollet Ave
Suite 201
Richfield, MN 55423-1669

Phone

(612) 866-2211

Fax

(612) 866-9217

NPI assigned

Sep 15, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Verne Betlach, R.PH., FIACP

Title

Pharmacist

Phone

(612) 866-2211

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1093811689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6519 NICOLLET AVE",
            "address_2": "SUITE 201",
            "city": "RICHFIELD",
            "state": "MN",
            "postal_code": "554231669",
            "telephone_number": "612-866-2211",
            "fax_number": "612-866-9217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6519 NICOLLET AVE",
            "address_2": "SUITE 201",
            "city": "RICHFIELD",
            "state": "MN",
            "postal_code": "554231669",
            "telephone_number": "612-866-2211",
            "fax_number": "612-866-9217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUSTOM RX COMPOUNDING PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BETLACH",
        "authorized_official_first_name": "VERNE",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "612-866-2211",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "R.PH., FIACP"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MN",
            "license": "261509-5",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kari Lynn Cox, PT
• Jalissa Cross
• Crystal Care Pca Inc
• Crystal Care Support Services, Inc
• Curantis HHC LLC
• Custom RX LLC
• Rebecca M. Dahlberg, M.D.
• Ambiyo Dakane
• Damascus Way
• Kirsten Louise Daniels, AU.D.

• Community/Retail Pharmacy in Richfield, MN
• Providers in Richfield, MN by specialty
• Community/Retail Pharmacy in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.