CUSTOMCEUTICAL COMPOUNDING, LLC (NPI# 1861782856) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861782856 |
| Entity Type | Organization |
| Organization Name | CUSTOMCEUTICAL COMPOUNDING, LLC |
| Practice Address |
4611 E Shea Blvd Bldg 3, Ste 180 Phoenix AZ 85028 |
| Mailing Address |
4611 E Shea Blvd Bldg 3, Ste 180 Phoenix AZ 85028-4254 |
| Practice Telephone | 4805160272 |
| Mailing Telephone | 4805160272 |
| Enumeration Date | 2011-04-12 |
| Last Update Date | 2018-08-29 |
| Authorized Official Name | MR. JAMES W BURCH (PARTNER) |
| Authorized Official Telephone | 4805160272 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 3336C0004X |
Pharmacy Specialization: Compounding Pharmacy |
Y005317 | AZ | Suppliers |
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Y005317 | AZ | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | 960917 | 05 |
| Street Address |
4611 E SHEA BLVD BLDG 3, STE 180 |
| City | PHOENIX |
| State | AZ |
| Zip Code | 85028 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457303471 | Ali M Mosharrafa | Surgery | 4611 E Shea Blvd, Suite 230, Phoenix, AZ 85028-4254 | 2006-05-17 |
| 1639435886 | Mosharrafa Plastic Surgery Plc | Surgery | 4611 E Shea Blvd, Suite 230, Phoenix, AZ 85028-4254 | 2012-04-02 |
| 1295015212 | Mosc, LLC | Clinic/Center | 4611 E Shea Blvd, Suite 100, Phoenix, AZ 85028-4254 | 2011-08-22 |
| 1609163542 | Jason A Kayce | Podiatrist | 4611 E Shea Blvd, Suite 160, Phoenix, AZ 85028-4254 | 2011-06-29 |
| 1497058143 | Susan K Oles Dmd Pllc | Dentist | 4611 E Shea Blvd, Suite 110, Phoenix, AZ 85028-4254 | 2010-12-17 |
| 1518273143 | Timothy C Schmidt | Dentist | 4611 E Shea Blvd, Ste 250 Bldg 1, Phoenix, AZ 85028-4254 | 2010-08-20 |
| 1467618850 | Kyle Vaughn | Podiatrist | 4611 E Shea Blvd, Suite 160, Phoenix, AZ 85028-4254 | 2008-08-05 |
| 1518161264 | Seivert Orthopedics and Sports Medicine,pc | Orthopaedic Surgery | 4611 E Shea Blvd, Suite 200, Phoenix, AZ 85028-4254 | 2007-06-14 |
| 1730232448 | Lauren Daniel Stegman | Radiology | 4611 E Shea Blvd, Ste 120, Phoenix, AZ 85028-4254 | 2007-01-18 |
| 1437175783 | Michael Anthony Seivert | Orthopaedic Surgery | 4611 E Shea Blvd, Suite 200, Phoenix, AZ 85028-4254 | 2006-07-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235626565 | Celice Korsten | Psychologist | 11020 N. Tatum Blvd., Ste. 100, Phoenix, AZ 85028 | 2018-04-23 |
| 1720591605 | Michele Kaplan | Counselor | 11640 N Tatum Blvd #3096, Phoenix, AZ 85028 | 2017-11-14 |
| 1154840304 | Faustino M. Gonzalez, Md PC | Anesthesiology | 11811 N. Tatum Blvd, Suite 3031, Phoenix, AZ 85028 | 2017-09-19 |
| 1679092514 | Savior Palliative Care LLC | Family Medicine | 4530 E Shea Blvd Ste 175, Phoenix, AZ 85028 | 2017-09-12 |
| 1437688892 | Harmony Behavioral Health | Behavioral Analyst | 3008 E Sierra St, Phoenix, AZ 85028 | 2017-06-08 |
| 1275949224 | Alexander D Garza | Podiatrist | 3101 E Shea Blvd Ste 220, Phoenix, AZ 85028 | 2014-07-09 |
| 1720418379 | Alyssa Hale | Occupational Therapy Assistant | 4600 East Shea Boulevard, Suite 101, Phoenix, AZ 85028 | 2013-11-19 |
| 1932534476 | Stephen Howard Garber | Otolaryngology | 9607 N. 43rd Way, Phoenix, AZ 85028 | 2013-09-03 |
| 1366798050 | Irna Lynn Shamos | Clinical Neuropsychologist | 4516 East Onyx Avenue, Arizona Psychological Diagnostics, Plc, Phoenix, AZ 85028 | 2012-07-31 |
| 1285930925 | Cathy Ann Payne | Nurse Practitioner | 11209 N Tatum Blvd Ste 260, Phoenix, AZ 85028 | 2011-01-27 |
| Find all providers in zip 85028 | ||||
| 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] |
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| 1821569633 | Healthrx Pharmacy, LLC. | Pharmacy | 727 E Bethany Home Rd Ste B110, Phoenix, AZ 85014-2151 | 2018-12-06 |
| 1821572405 | Tramanto Community Pharmacy | Pharmacy | 2633 W Carefree Hwy Ste 115, Phoenix, AZ 85085-8864 | 2018-09-19 |
| 1699254839 | Corner Pharmacy Incorporated | Pharmacy | 112 N 5th Ave Ste 101, Phoenix, AZ 85003 | 2018-08-08 |
| 1053818096 | Nixona Rx, LLC | Pharmacy | 1614 E Mcdowell Rd, Phoenix, AZ 85006-3032 | 2018-04-06 |
| 1841795887 | Nimble Pharmacy Inc | Pharmacy | 3702 E Roeser Rd Ste 5, Phoenix, AZ 85040-9047 | 2018-03-29 |
| 1881107696 | Julie Faye House | Pharmacy | 2655 E Brown St, Phoenix, AZ 85028-4314 | 2017-11-15 |
| 1295248268 | German Dobson Cvs, L.L.C. | Pharmacy | 5450 W Happy Valley Rd, Phoenix, AZ 85083-2949 | 2017-11-13 |
| 1073069860 | Bgh Pharmacy | Pharmacy | 3544 W Glendale Ave Ste E, Phoenix, AZ 85051-8359 | 2016-08-31 |
| Find all providers in PHOENIX | ||||
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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.