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Organization
CUSTOM RX, PC
Active
Organization
CUSTOM RX, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MIKE D. HOLCOMB PHARMD (PHARMACIST/OWNER)
(308) 872-5602
Entity
Organization
Contact information
Practice address
540 S 8TH AVE STE B, BROKEN BOW, NE 68822-2456
(308) 872-5602
(308) 872-2377
Mailing address
540 S 8TH AVE STE B, BROKEN BOW, NE 68822-2456
(308) 872-5602
(308) 872-2377
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
2818
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2816265
NCPDP
NE
Enumeration date
03/03/2009
Last updated
03/03/2009
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