Customceutical Compounding, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

Y005317 Issued in AZ

Legal business name

CUSTOMCEUTICAL COMPOUNDING, LLC

Practice address

4611 E Shea Blvd
BLDG 3, Ste 180
Phoenix, AZ 85028

Phone

(480) 516-0272

NPI assigned

Apr 12, 2011

Organization subpart

No

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

Authorized official

Name

Mr. James W Burch

Title

Partner

Phone

(480) 516-0272

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1302566400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1535500800000",
    "number": "1861782856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4611 E SHEA BLVD",
            "address_2": "BLDG 3, STE 180",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850284254",
            "telephone_number": "480-516-0272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4611 E SHEA BLVD",
            "address_2": "BLDG 3, STE 180",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85028",
            "telephone_number": "480-516-0272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUSTOMCEUTICAL COMPOUNDING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-12",
        "last_updated": "2018-08-29",
        "status": "A",
        "authorized_official_last_name": "BURCH",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "480-516-0272",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AZ",
            "license": "Y005317",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "AZ",
            "license": "Y005317",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "960917",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Taylor Cushman, MD
• Jeffrey Michael Cusick, MD
• Matthew Garrett Cusick, M.D.
• Jason Anthony Cusimano, MD
• Annie L Custer, LCSW
• Cute Smiles 4 Kids
• Cute Smiles 4 Kids, LLC
• Suzanne Cutler
• Teresa Cutrie, LMSW
• Brent M Cutshall, MD

• Community/Retail Pharmacy in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Community/Retail Pharmacy in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2018; 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.