# CUSTOM MED, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CUSTOM MED LLC
- **Other names:** Prime Plus Lakeview
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1700636271
- **Legal business name:** CUSTOM MED LLC
- **Authorized official:** INAS DAHABRA (MEMBER, PRESIDENT)
- **Authorized official phone:** (708) 289-6721

## Contact information

- **Practice address:** 3156 N. CLARK, CHICAGO, IL 60657
- **Practice address phone:** (773) 568-8340
- **Mailing address:** 3156 N. CLARK, CHICAGO, IL 60657
- **Mailing address phone:** (708) 289-6721

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 183500000X | Pharmacist | — | NULL | — |
| 183500000X | Pharmacist | — | — | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 03/26/2024
- **Last updated:** 10/02/2024