1982329835 NPI number — CUSTOM PRESCRIPTIONS INC.

Table of content: (NPI 1982329835)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982329835 NPI number — CUSTOM PRESCRIPTIONS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CUSTOM PRESCRIPTIONS INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982329835
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
424 E ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRBURY
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68352-2535
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-729-2620
Provider Business Mailing Address Fax Number:
402-729-3305

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
424 E ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRBURY
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68352-2535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-729-2620
Provider Business Practice Location Address Fax Number:
402-729-3305
Provider Enumeration Date:
10/04/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CLABAUGH
Authorized Official First Name:
NATHAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/RP
Authorized Official Telephone Number:
402-729-2620

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)