NPIMap

Organization Active NPI

Custom Plus Pharmacy LLC

Doing business as Custom Plus Pharmacy

  • Community/Retail Pharmacy
  • West Lafayette, IN
National Provider Identifier
1477813970
Registry record updated May 18, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
60006301A Issued in IN
Legal business name
CUSTOM PLUS PHARMACY LLC
Doing business as
Custom Plus Pharmacy
Practice address
482 W Navajo St Ste a
West Lafayette, IN 47906-1940
Phone
(765) 463-2600
Fax
(765) 463-2601
NPI assigned
May 18, 2012
Last updated
May 18, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2012

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

Authorized official

Name
Benjamin RachwalNPI 1144337064
Title
Owner
Phone
(765) 463-2600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 60006301A IN Primary
Compounding Pharmacy 3336C0004X

Addresses

Primary practice location

482 W Navajo St Ste a
West Lafayette, IN 47906-1940

Mailing address

482 W Navajo St Ste a
West Lafayette, IN 47906-1940
Phone (765) 463-2600

Other identifiers 1

IdentifierTypeStateIssuer
1563798OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • Custom Plus Pharmacy Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1337299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337299200000",
    "number": "1477813970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "482 W NAVAJO ST STE A",
            "city": "WEST LAFAYETTE",
            "state": "IN",
            "postal_code": "479061940",
            "telephone_number": "765-463-2600",
            "fax_number": "765-463-2601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "482 W NAVAJO ST STE A",
            "city": "WEST LAFAYETTE",
            "state": "IN",
            "postal_code": "479061940",
            "telephone_number": "765-463-2600",
            "fax_number": "765-463-2601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUSTOM PLUS PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-18",
        "last_updated": "2012-05-18",
        "status": "A",
        "authorized_official_last_name": "RACHWAL",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "765-463-2600"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IN",
            "license": "60006301A",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "1563798",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Custom Plus Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Lafayette, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 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.