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Organization
CUSTOM HEALTH PHARMACY INC
Active
Organization
CUSTOM HEALTH PHARMACY INC
Active
Other names
Custom Health Pharmacy, Inc
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN SOWINSKI (PHARMACIST/PRESIDENT)
(920) 482-3145
Entity
Organization
Contact information
Practice address
844 WILLARD DR STE 7, GREEN BAY, WI 54304-5265
(920) 884-7345
(920) 884-7346
Mailing address
844 WILLARD DR STE 7, GREEN BAY, WI 54304-5265
(920) 884-7345
(920) 884-7346
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0004X
Compounding Pharmacy
Primary
9354-42
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2133536
PK
—
Enumeration date
07/01/2008
Last updated
05/16/2016
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