Custom Compounding Centers LLC

Primary specialty

Compounding PharmacyTaxonomy code 3336C0004X

License

PHY 50368 Issued in CA

Legal business name

CUSTOM COMPOUNDING CENTERS LLC

Doing business as

Custom Compounding Centers

Practice address

10525 Humbolt St
Los Alamitos, CA 90720-5401

Phone

(714) 894-2120

Fax

(714) 894-2150

NPI assigned

Feb 17, 2010

Last updated

Jan 14, 2014By 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

Paul Wheeler

Title

Pic

Phone

(714) 824-2120

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• CUSTOM COMPOUNDING CENTERS Doing business as

Locations

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

{
    "created_epoch": "1266364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389657600000",
    "number": "1902128911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10525 HUMBOLT ST",
            "city": "LOS ALAMITOS",
            "state": "CA",
            "postal_code": "907205401",
            "telephone_number": "714-894-2120",
            "fax_number": "714-894-2150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10525 HUMBOLT ST",
            "city": "LOS ALAMITOS",
            "state": "CA",
            "postal_code": "907205401",
            "telephone_number": "714-894-2120",
            "fax_number": "714-894-2150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUSTOM COMPOUNDING CENTERS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-17",
        "last_updated": "2014-01-14",
        "status": "A",
        "authorized_official_last_name": "WHEELER",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "PIC",
        "authorized_official_telephone_number": "714-824-2120"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "CA",
            "license": "PHY 50368",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "0590388",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CUSTOM COMPOUNDING CENTERS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ctr Medical Enterprises, Inc
• Keith D Curcillo, D,C.
• Sarah Rose Curry
• Mario Curti, M.D.
• Tyson O Curtis, DDS
• Cynthia W Chao D O a Professional Corporation
• Cynthia W Chao D O a Professional Corporation
• David Nima Dabiri
• Dahn Medical Inc
• Reza Danesh, MD

• Compounding Pharmacy in Los Alamitos, CA
• Providers in Los Alamitos, CA by specialty
• Compounding Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2014; 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.