CUSTOM COMPOUNDING PHARMACY LLC (NPI# 1417095407) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417095407 |
| Entity Type | Organization |
| Organization Name | CUSTOM COMPOUNDING PHARMACY LLC |
| Other Organization Name | CUSTOM COMPOUNDING PHY LLC |
| Practice Address |
3816 Ringgold Rd Chattanooga TN 37412-1640 |
| Practice Telephone | 4236290353 |
| Practice Fax Number | 4236299646 |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2007-07-20 |
| Authorized Official Name | JOE MUSICK (PHARMACIST) |
| Authorized Official Telephone | 4236290353 |
| Authorized Official Credential | RPH |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers | ||
| N | 3336C0004X |
Pharmacy Specialization: Compounding Pharmacy |
Suppliers | ||
| N | 333600000X | Pharmacy | Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
0000003295 | TN | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OTHER ID NUMBER | 4432061 | 01 | |
| OTHER ID NUMBER-COMMERCIAL NUMBER | 4432061 | 01 |
| Other Name | Type Code |
|---|---|
| CUSTOM COMPOUNDING PHY LLC | Doing Business As Name - Organization |
| Street Address |
3816 RINGGOLD RD |
| City | CHATTANOOGA |
| State | TN |
| Zip Code | 37412-1640 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316482458 | East Ridge Snf Operations, LLC | Skilled Nursing Facility | 1502 Mcdonald Rd., East Ridge, TN 37412 | 2016-12-28 |
| 1487080149 | Puckett Med Van LLC | Non-emergency Medical Transport (VAN) | 5603 Ringgold Road, East Ridge, TN 37412 | 2013-09-25 |
| 1538420229 | Nathan Hartgrove | Internal Medicine | 961 Spring Creek Rd Ste 300, Chattanooga, TN 37412 | 2012-05-30 |
| 1770869042 | Jonathan Bailey Barnett I | Pharmacist | 5301 Ringold Rd, East Ridge, TN 37412 | 2011-10-31 |
| 1932482791 | Ronald P Leonard | Pharmacist | 7354 East Brainerd Rd, Chattanooga, TN 37412 | 2011-09-27 |
| 1164758561 | Zoilus, Inc | Home Health | 912 Belvoir Hills Circle, Chattanooga, TN 37412 | 2009-10-20 |
| 1093935157 | Alan L Crisman | Dentist | 1421 Armour Street, Chattanooga, TN 37412 | 2007-04-30 |
| 1700949989 | Keith Brian Sparkman | Optometrist | 1013 Spring Creek Rd, Chattanooga, TN 37412 | 2006-12-18 |
| 1174617161 | Shahul H Majeed | Obstetrics & Gynecology | 1012 Spring Creek Road, Chattanooga, TN 37412 | 2006-10-03 |
| 1356434070 | Mckinley Snipes Lundy Sr. | Preventive Medicine | 931 Spring Creek Road, Suite 200, Chattanooga, TN 37412 | 2006-10-02 |
| Find all providers in zip 37412 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811522485 | On Site Rx Inc | Pharmacy | 3074 Hickory Valley Rd Bldg 229, Chattanooga, TN 37421-1273 | 2020-03-04 |
| 1073170718 | A Pharmacy LLC | Pharmacy | 4767 Hwy 58, Suite 101, Chattanooga, TN 37416 | 2019-05-28 |
| 1982952917 | Carestar Pharmacy | Pharmacy | 6106 Shallowford Rd Ste 108, Chattanooga, TN 37421-2280 | 2012-08-23 |
| 1548584634 | Eastside Pharmacy Inc | Pharmacy | 6857 Lee Hwy, Chattanooga, TN 37421-6406 | 2010-03-18 |
| 1538342076 | Ross Enterprise Inc | Pharmacy | 2001 E Third St Suite C, Chattanooga, TN 37404-2610 | 2007-12-06 |
| 1699831966 | Deems S Riddle IIi | Pharmacy | 4335 Ringgold Rd, Chattanooga, TN 37412-2740 | 2006-12-29 |
| 1952496804 | Pulmonaire Service Pharmacy, Inc. | Pharmacy | 821 Mccallie Ave, Chattanooga, TN 37403-2613 | 2006-10-04 |
| 1215030911 | Tennessee Cvs Pharmacy LLC | Pharmacy | 5501 Brainerd Rd, Chattanooga, TN 37411-5309 | 2006-09-07 |
| 1306949003 | Tennessee Cvs Pharmacy LLC | Pharmacy | 5011 State St # A, Chattanooga, TN 37407-3519 | 2006-09-07 |
| 1073616785 | Tennessee Cvs Pharmacy LLC | Pharmacy | 321 Browns Ferry Rd, Chattanooga, TN 37419-1546 | 2006-09-07 |
| Find all providers in CHATTANOOGA | ||||
| City | CHATTANOOGA |
| Zip Code | 37412 |
Please comment or provide details below to improve the information on CUSTOM COMPOUNDING PHARMACY LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.