Custom Care Pharmacy, LLC
Organization Active NPI Community/Retail Pharmacy · Clinton, MS
NPI 1730510074 · NPPES record last updated Dec 12, 2013
Key facts
- NPI
- 1730510074
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 07892/2.2 (MS)
- Legal business name
- CUSTOM CARE PHARMACY, LLC
- Practice address
- 132 E Northside Dr
Suite C
Clinton, MS 39056-3415 - Phone
- (601) 488-4360
- Fax
- (877) 747-5326
- NPI assigned
- Dec 12, 2013
- Organization subpart
- No
Authorized official
- Name
- Marco Moran
- Title
- Pharmicist-in-Charge
- Phone
- (318) 791-3765
National Provider Directory
Locations
132 E Northside Dr
Ste C
Clinton, MS 39056
Phone (601) 488-4360
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 07892/2.2 | MS | Yes |
| Compounding Pharmacy | 3336C0004X | |||
| Specialty Pharmacy | 3336S0011X |
Addresses
Primary practice location
132 E Northside Dr
Suite C
Clinton, MS 39056-3415
Mailing address
132 E Northside Dr
Suite C
Clinton, MS 39056-3415
Phone (601) 488-4360
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2143363 | Other | PK |
Other names
- Custom Care Pharmacy
Other providers in Clinton, MS
- Jessie M Coy
- Anita Craft
- Creative Sisters Counseling LLC
- Dru Fulton Crenshaw
- Jessica R Cronn
- Custom Prosthetic & Orthotic
- George Cutrer
- David Brock Damon
- Gloria Daniels
- Levon Daniels
All providers in Clinton, MS · Community/Retail Pharmacy in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 12, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.