# CUSTOM CARE PHARMACY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Custom Care Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1730510074
- **Authorized official:** MARCO MORAN (PHARMICIST-IN-CHARGE)
- **Authorized official phone:** (318) 791-3765

## Contact information

- **Practice address:** 132 E NORTHSIDE DR, SUITE C, CLINTON, MS 39056-3415
- **Practice address phone:** (601) 488-4360
- **Practice address fax:** (877) 747-5326
- **Mailing address:** 132 E NORTHSIDE DR, SUITE C, CLINTON, MS 39056-3415
- **Mailing address phone:** (601) 488-4360
- **Mailing address fax:** (877) 747-5326

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 07892/2.2 | MS | Yes |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |
| 3336S0011X | Specialty Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 12/12/2013
- **Last updated:** 12/12/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2143363 | PK | — |