CUSTOM RX, PC (NPI# 1790925725) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790925725 |
| Entity Type | Organization |
| Organization Name | CUSTOM RX, PC |
| Practice Address |
540 S 8th Ave Ste B Broken Bow NE 68822-2456 |
| Practice Telephone | 3088725602 |
| Practice Fax Number | 3088722377 |
| Mailing Telephone | 3088725602 |
| Mailing Fax Number | 3088722377 |
| Enumeration Date | 2009-03-03 |
| Last Update Date | 2009-03-03 |
| Authorized Official Name | DR. MIKE D. HOLCOMB (PHARMACIST/OWNER) |
| Authorized Official Telephone | 3088725602 |
| Authorized Official Credential | PHARMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336C0004X |
Pharmacy Specialization: Compounding Pharmacy |
2818 | NE | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NE | NCPDP | 2816265 | 01 |
| Street Address |
540 S 8TH AVE STE B |
| City | BROKEN BOW |
| State | NE |
| Zip Code | 68822-2456 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659898229 | Lauren Eliz Zimbelman | Occupational Therapy Assistant | Brookestone View, 850 Laurel Parkway Drive, Broken Bow, NE 68822 | 2017-08-24 |
| 1063868032 | Tanner Johnson | Specialist/Technologist | 79568 Sumner Rd., Broken Bow, NE 68822 | 2016-05-10 |
| 1730571837 | Quality Senior Villages | Clinic/Center | 715 Arapahoe Lane, Broken Bow, NE 68822 | 2015-02-26 |
| 1346660743 | Sheila Erickson | Case Manager/Care Coordinator | 323 S 7th Street, Broken Bow, NE 68822 | 2014-04-24 |
| 1497926570 | Sarah Tove Hansen | Community Health Worker | 850 Laurel Parkway Dr, Broken Bow, NE 68822 | 2008-03-18 |
| 1144320144 | John C Evans | Nurse Anesthetist, Certified Registered | 145 Memorial Dr., Broken Bow, NE 68822 | 2006-09-22 |
| 1588764583 | Timothy Bart Johnson | Nurse Anesthetist, Certified Registered | 79568 Sumner Road, Broken Bow, NE 68822 | 2006-09-22 |
| 1578668232 | Central Nebraska Medical Clinic PC | Family Medicine | 145 Memorial Drive, Broken Bow, NE 68822 | 2006-09-14 |
| 1366544033 | Robert R Kahnk | Family Medicine | 145 Memorial Dr, Broken Bow, NE 68822 | 2006-09-02 |
| 1891897997 | David A Minnick | Family Medicine | 145 Memorial Dr, Broken Bow, NE 68822 | 2006-09-01 |
| Find all providers in zip 68822 | ||||
| Taxonomy Code | 3336C0004X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Compounding Pharmacy |
| A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner’s Prescription Drug Order or initiative based on the Practitioner/Patient/Pharmacist relationship in the course of professional practice. A compounding pharmacy utilizes specialized equipment and specially designed facilities necessary to meet the legal and quality requirements of its scope of compounding practice. |
| Notes: Sources: NABP Model Practice Act, Appendix C - Good Compounding Practice, USP <795> and <797>, and Pharmacy Compounding Accreditation Board [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578584538 | Sherrills Corporation | Pharmacy | 101 Main St, Broken Bow, OK 74728-3973 | 2006-07-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497388649 | Group Dpc, LLC | Pharmacy | 2206 Longo Dr Ste 209, Bellevue, NE 68005-2977 | 2020-02-17 |
| 1386283893 | Jkrxllc | Pharmacy | 13110 W Dodge Rd Ste B, Omaha, NE 68154-2102 | 2019-12-31 |
| 1235783945 | Innovative Rx, P.C. | Pharmacy | 416 W 48th St Ste 20, Kearney, NE 68845-1315 | 2019-07-31 |
| 1174976427 | Jsk Dba Rxsolutions | Pharmacy | 1225 Golden Gate Dr, Papillion, NE 68046-2837 | 2016-07-21 |
| 1285035261 | Valley Apothecary | Pharmacy | 123 E Gardiner St, Suite A, Valley, NE 68064-9798 | 2014-09-10 |
| 1194027177 | Vets First Choice | Pharmacy | 5013 S 110th St, Omaha, NE 68137-2376 | 2010-11-24 |
| 1245564012 | Optum Infusion Services 302, LLC | Pharmacy | 8720 South 114th Street, Suite 106, La Vista, NE 68128 | 2009-09-28 |
| 1730326844 | Silver Street Compounding Pharmacy, Inc. | Pharmacy | 1415 Silver St, Ashland, NE 68003-1845 | 2009-01-12 |
| 1407033855 | Kubat Custom Health Care Inc | Pharmacy | 4924 Center St Ste A1, Omaha, NE 68106-3219 | 2008-01-29 |
| 1144374679 | Tran Pharmacy Inc | Pharmacy | 2655 S 70th St, Ste C, Lincoln, NE 68506-2908 | 2007-01-22 |
| Find all providers with the same taxonomy | ||||
| City | BROKEN BOW |
| Zip Code | 68822 |
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| 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.