CUSTOM HEALTHCARE COMPOUNDING PHARMACY (NPI# 1467794552) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467794552 |
| Entity Type | Organization |
| Organization Name | CUSTOM HEALTHCARE COMPOUNDING PHARMACY |
| Practice Address |
24022 Calle De La Plata Ste 510 Laguna Hills CA 92653-3631 |
| Practice Telephone | 9495952273 |
| Practice Fax Number | 9495952275 |
| Mailing Telephone | 9495952273 |
| Mailing Fax Number | 9495952275 |
| Enumeration Date | 2013-03-27 |
| Last Update Date | 2015-09-28 |
| Authorized Official Name | ANHVUONG LY (PHARMACIST IN CHARGE) |
| Authorized Official Telephone | 9253308975 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1835P0018X |
Pharmacist Specialization: Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
51905 | CA | Pharmacy Service Providers |
| Street Address |
24022 CALLE DE LA PLATA STE 510 |
| City | LAGUNA HILLS |
| State | CA |
| Zip Code | 92653-3631 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932708476 | Nikkie Veyseh | Behavior Technician | 26921 Falling Leaf Dr., Laguna Hills, CA 92653 | 2020-10-24 |
| 1609480425 | Steve Ceja | Behavior Technician | 25201 Paseo De Alicia Suite 110, Laguna Hills, CA 92653 | 2020-08-31 |
| 1467006882 | Kristina Alexa Puno Morales | Dietitian, Registered | 24552 Health Center Drive, Laguna Hills, CA 92653 | 2019-07-25 |
| 1164929626 | Shoreline Consulting Services, Inc. | Clinic/Center | 23010 Lake Forest Drive, Suite B, Laguna Hills, CA 92653 | 2018-04-11 |
| 1023511045 | Performance Health Medical Group | Non-Pharmacy Dispensing Site | 25431 Cabot Road Suite 118, Laguna Hills, CA 92653 | 2018-03-15 |
| 1831613850 | Stephani A Berg | Physical Medicine & Rehabilitation | 24422 Avenida De La Carlota Suite 190, Laguna Hills, CA 92653 | 2017-08-01 |
| 1497299945 | Stephanie Lyle | Nurse Practitioner | 24221 Calle De Louisa, Suite 400, Laguna Hills, CA 92653 | 2016-12-16 |
| 1053776278 | Meillanny Gladness | Counselor | 23151 Verdugo Dr Ste 203, Laguna Hills, CA 92653 | 2015-12-16 |
| 1912383183 | Pmdca, LLC | Clinical Medical Laboratory | 23297 S Pointe Dr Ste 100, Laguna Hills, CA 92653 | 2015-08-10 |
| 1821486630 | 4mpw, Inc. | Home Health | 23232 Peralta Drive 216, Laguan Hills, CA 92653 | 2014-12-31 |
| Find all providers in zip 92653 | ||||
| Taxonomy Code | 1835P0018X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| Specialization | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
| Pharmacist Clinician/Clinical Pharmacy Specialist is a pharmacist with additional training and an expanded scope of practice that may include prescriptive authority, therapeutic management, and disease management. |
| Notes: Source: National Uniform Claim Committee, 2007 [1/1/2008: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376142430 | Daria Mohazzab Hosseinian | Pharmacist | 450 E Spring St Ste 11, Long Beach, CA 90806-1625 | 2020-10-20 |
| 1235745100 | Ngoc Tran | Pharmacist | 10371 Luders Ave, Garden Grove, CA 92843-3213 | 2020-09-16 |
| 1275143752 | Sherine Ann Legge | Pharmacist | 17 Westchester Ct, Trabuco Canyon, CA 92679-4955 | 2020-08-09 |
| 1922618412 | Ashley Keane Hayes | Pharmacist | 6551 E El Pulcro St, Long Beach, CA 90815-2302 | 2020-08-09 |
| 1750991543 | Priyankumar Arvind Patel | Pharmacist | 2339 S G St, Fresno, CA 93721-3425 | 2020-08-05 |
| 1912521261 | Sharon Jung | Pharmacist | 851 Langholm Way, Riverside, CA 92508-6075 | 2020-06-02 |
| 1710500376 | Christine Nguyen | Pharmacist | 2248 E Nyon Ave, Anaheim, CA 92806-4634 | 2020-05-18 |
| 1134740582 | Cj3m Corporation | Pharmacist | 2626 El Camino Real Ste A, Carlsbad, CA 92008-1253 | 2020-04-27 |
| 1629607775 | Tiffany Chang | Pharmacist | 213 Quarry Rd Rm 2726a, Palo Alto, CA 94304-1416 | 2020-04-01 |
| 1124655782 | Noor Mikhail | Pharmacist | 220 W Main St Ste 102, El Cajon, CA 92020-3462 | 2020-03-24 |
| Find all providers with the same taxonomy | ||||
| City | LAGUNA HILLS |
| Zip Code | 92653 |
Please comment or provide details below to improve the information on CUSTOM HEALTHCARE COMPOUNDING PHARMACY.
| 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.