Custom Care Compounding Pharmacy, Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY51117 Issued in CA

Legal business name

CUSTOM CARE COMPOUNDING PHARMACY, INC.

Practice address

18080 San Ramon Valley Blvd
Suite 104
San Ramon, CA 94583-4437

Phone

(925) 962-5303

NPI assigned

Oct 30, 2012

Organization subpart

No

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

Authorized official

Name

Miss Regina Woeger

Title

Co-Owner

Phone

(925) 962-5303

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1351555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351555200000",
    "number": "1285988287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18080 SAN RAMON VALLEY BLVD",
            "address_2": "SUITE 104",
            "city": "SAN RAMON",
            "state": "CA",
            "postal_code": "945834437",
            "telephone_number": "925-962-5303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18080 SAN RAMON VALLEY BLVD",
            "address_2": "SUITE 104",
            "city": "SAN RAMON",
            "state": "CA",
            "postal_code": "945834437",
            "telephone_number": "925-962-5303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUSTOM CARE COMPOUNDING PHARMACY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-30",
        "last_updated": "2012-10-30",
        "status": "A",
        "authorized_official_last_name": "WOEGER",
        "authorized_official_first_name": "REGINA",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "925-962-5303",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY51117",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA STATE LICENSE",
            "identifier": "PHY51117",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Community/Retail Pharmacy in San Ramon, CA
• Providers in San Ramon, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2012; 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.