Custom RX LLC

Primary specialty

Compounding PharmacyTaxonomy code 3336C0004X

License

263528 Issued in MN

Legal business name

CUSTOM RX LLC

Doing business as

Custom Rx Compounding Pharmacy

Practice address

6519 Nicollet Ave
Ste 201
Richfield, MN 55423-1669

Phone

(612) 866-2211

Fax

(612) 866-9217

NPI assigned

Jun 4, 2010

Organization subpart

No

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

Authorized official

Name

Mr. Roy David Katz, R.PH.

Title

Owner

Phone

(612) 866-2211

Specialties & licenses 1

Addresses

Other names 1

• Custom Rx Compounding Pharmacy Doing business as

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

{
    "created_epoch": "1275609600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1275609600000",
    "number": "1922328657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6519 NICOLLET AVE",
            "address_2": "STE 201",
            "city": "RICHFIELD",
            "state": "MN",
            "postal_code": "554231669",
            "telephone_number": "612-866-2211",
            "fax_number": "612-866-9217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6519 NICOLLET AVE",
            "address_2": "STE 201",
            "city": "RICHFIELD",
            "state": "MN",
            "postal_code": "554231669",
            "telephone_number": "612-866-2211",
            "fax_number": "612-866-9217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUSTOM RX LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-04",
        "last_updated": "2010-06-04",
        "status": "A",
        "authorized_official_last_name": "KATZ",
        "authorized_official_first_name": "ROY",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-866-2211",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "R.PH."
    },
    "taxonomies": [
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "MN",
            "license": "263528",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Custom Rx Compounding Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Compounding Pharmacy in Richfield, MN
• Providers in Richfield, MN by specialty
• Compounding Pharmacy in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2010; 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.