Custom Med Apothecary

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

60005496A Issued in IN

Legal business name

CUSTOM MED APOTHECARY

Practice address

5510 Lafayette Rd
Suite 260
Indianapolis, IN 46254-1685

Phone

(317) 803-3436

Fax

(317) 803-3437

NPI assigned

May 21, 2007

Organization subpart

No

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

Authorized official

Name

Jeff Jackson, R.PH.

Title

Member

Phone

(317) 803-3436

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jeffrey W Jackson, R.PH.

  • Pharmacist
  • Indianapolis, IN
  • NPI 1952421927
  NPD (past)

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

{
    "created_epoch": "1179705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1497963540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5510 LAFAYETTE RD",
            "address_2": "SUITE 260",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462541685",
            "telephone_number": "317-803-3436",
            "fax_number": "317-803-3437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5510 LAFAYETTE RD",
            "address_2": "SUITE 260",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462541685",
            "telephone_number": "317-803-3436",
            "fax_number": "317-803-3437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUSTOM MED APOTHECARY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "317-803-3436",
        "authorized_official_credential": "R.PH."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IN",
            "license": "60005496A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amber Shanta Cushenberry
• Lisa J. Cushman, M.S., PH.D.
• Emma Cusic, LSW
• Jordan Haymond Cuskaden, MD
• Sarah Catherine Cuskaden, LMHC
• Cutaneous and Maxillofacial Pathology Laboratory PC
• Cutaneous and Maxillofacial Pathology Laboratory, PC
• Schuyler Cutchin
• William B Cutcliff, MD
• Gordon B Cutler Jr., MD

• Community/Retail Pharmacy in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Community/Retail Pharmacy in Indiana

• 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.