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Organization
CUSTOM MADE PHARMACY INC
Active
Organization
CUSTOM MADE PHARMACY INC
Active
Other names
SPECIALITY COMPOUNDING PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID KOHANJASH (SECRETARY)
(818) 308-8314
Entity
Organization
Contact information
Practice address
13322 RIVERSIDE DR, SHERMAN OAKS, CA 91423-2509
(818) 789-8111
(818) 789-6548
Mailing address
13322 RIVERSIDE DR, SHERMAN OAKS, CA 91423-2509
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
48534
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5626289
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
03/09/2007
Last updated
02/11/2009
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