Custom Pharmacy Services LLC

Primary specialty

Compounding PharmacyTaxonomy code 3336C0004X

License

PP482248 Issued in PA

Legal business name

CUSTOM PHARMACY SERVICES LLC

Doing business as

Custom Pharmacy Services

Practice address

517 Main St
Duryea, PA 18642-1323

Phone

(570) 213-5561

Fax

(888) 676-5833

NPI assigned

Mar 22, 2012

Last updated

May 29, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Christine Sebastianelli

Title

President

Phone

(888) 997-4276

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Custom Pharmacy Services Doing business as

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

{
    "created_epoch": "1332374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1432857600000",
    "number": "1588939615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "517 MAIN ST",
            "city": "DURYEA",
            "state": "PA",
            "postal_code": "186421323",
            "telephone_number": "570-213-5561",
            "fax_number": "888-676-5833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "517 MAIN ST",
            "city": "DURYEA",
            "state": "PA",
            "postal_code": "186421323",
            "telephone_number": "570-213-5561",
            "fax_number": "888-676-5833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUSTOM PHARMACY SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-22",
        "last_updated": "2015-05-29",
        "status": "A",
        "authorized_official_last_name": "SEBASTIANELLI",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "888-997-4276"
    },
    "taxonomies": [
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "PA",
            "license": "PP482248",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2135415",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Custom Pharmacy Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Compounding Pharmacy in Duryea, PA
• Providers in Duryea, PA by specialty
• Compounding Pharmacy in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2015; 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.