Custom Med, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

CUSTOM MED, LLC

Practice address

3156 N. Clark
Chicago, IL 60657

Phone

(773) 568-8340

NPI assigned

Mar 26, 2024

Organization subpart

Yes

Parent organization

CUSTOM MED LLCAs reported in NPPES

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

Authorized official

Name

Inas Dahabra

Title

Member, President

Phone

(708) 289-6721

Specialties & licenses 2

Addresses

Other names 1

• Prime Plus Lakeview Doing business as

Tax ID family

Custom Med LLC2 organizations share this tax ID, including this one

Part of

Custom Med LLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Custom Med, LLC

  • Pharmacy
  • Chicago, IL
  • NPI 1467823815
  NPD tax ID

Locations

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

{
    "created_epoch": "1711411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727827200000",
    "number": "1700636271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3156 N. CLARK",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60657",
            "telephone_number": "708-289-6721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3156 N. CLARK",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60657",
            "telephone_number": "773-568-8340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUSTOM MED, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CUSTOM MED LLC",
        "enumeration_date": "2024-03-26",
        "last_updated": "2024-10-02",
        "certification_date": "2024-10-02",
        "status": "A",
        "authorized_official_last_name": "DAHABRA",
        "authorized_official_first_name": "INAS",
        "authorized_official_title_or_position": "MEMBER, PRESIDENT",
        "authorized_official_telephone_number": "708-289-6721"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prime Plus Lakeview",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Corazon B Custodio, MD
• Custom Healing and Wellness Ministries, NFP
• Custom Home Care, Inc.
• Custom Med, LLC
• Custom Med, LLC
• Customfit Concierge Medicine, Health and Fitness LLC
• Cutest Smile LTD.
• Danielle Cuthbert, MD
• Jennifer P Cutilletta, LCSW
• Amy Cutler, MS, OTR/L

• Community/Retail Pharmacy in Chicago, IL
• Providers in Chicago, IL by specialty
• Community/Retail Pharmacy in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2024; 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.