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Organization

CUSTOMPP LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MATTHEW HUTERA (OWNER)
(765) 463-2600
Entity
Organization

Contact information

Practice address
482 W NAVAJO ST STE A, WEST LAFAYETTE, IN 47906-1940
(765) 463-2600
(765) 463-2601
Mailing address
482 W NAVAJO ST STE A, WEST LAFAYETTE, IN 47906-1940
(765) 463-2600
(765) 463-2601

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
333600000X
Pharmacy
3336C0003X
Community/Retail Pharmacy
Primary
60006301A
IN
3336C0004X
Compounding Pharmacy

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2135170
PK
05
300033680
IN
Enumeration date
03/28/2012
Last updated
05/25/2022
About Stedi
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