Organization
CUSTOM CARE COMPOUNDING PHARMACY, INC.
Active
Organization
CUSTOM CARE COMPOUNDING PHARMACY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS REGINA WOEGER (CO-OWNER)
(925) 962-5303
Entity
Organization
Contact information
Practice address
18080 SAN RAMON VALLEY BLVD, SUITE 104, SAN RAMON, CA 94583-4437
(925) 962-5303
Mailing address
18080 SAN RAMON VALLEY BLVD, SUITE 104, SAN RAMON, CA 94583-4437
(925) 962-5303
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY51117
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PHY51117
CALIFORNIA STATE LICENSE
CA
Enumeration date
10/30/2012
Last updated
10/30/2012
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