Customized Medication, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

60005663A Issued in IN

Legal business name

CUSTOMIZED MEDICATION, LLC

Practice address

541 Roske Dr Ste E
Elkhart, IN 46516-9323

Phone

(574) 522-1940

Fax

(574) 522-1990

NPI assigned

Jun 21, 2008

Organization subpart

No

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

Authorized official

Name

Richard Sargent

Title

Owner

Phone

(574) 522-1940

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1214006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366761600000",
    "number": "1497916548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "58147 DIENER DR",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465287723",
            "telephone_number": "574-522-1940",
            "fax_number": "574-522-1990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "541 ROSKE DR STE E",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465169323",
            "telephone_number": "574-522-1940",
            "fax_number": "574-522-1990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUSTOMIZED MEDICATION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-21",
        "last_updated": "2013-04-24",
        "status": "A",
        "authorized_official_last_name": "SARGENT",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "574-522-1940"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "IN",
            "license": "60005663A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Demara Cunningham
• Willard Keith Cupp III, PMHNP
• Madeline Curran
• Alexis Curry
• Marissa Diane Curry
• David A Cutcliffe, MD
• Cutting Edge Integrative Pain Centers LLC
• Marcus Cyprian Sr.
• D J Shirley DC PC
• D&a Dissolving, Inc.

• Clinic/Center in Elkhart, IN
• Providers in Elkhart, IN by specialty
• Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2013; 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.