Organization
CUSTOM RX
Active
Other names
Custom Rx Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
TRAVIS WALTHALL (PHARMACIST/MANAGER)
(208) 631-8141
Entity
Organization
Contact information
Practice address
173 W 4TH ST, KUNA, ID 83634-2046
(208) 922-4400
(208) 922-4499
Mailing address
PO BOX 246, KUNA, ID 83634-0246
(208) 922-4400
(208) 922-4499
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
2399RP
ID
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2123536
PK
—
Enumeration date
01/20/2010
Last updated
06/17/2016
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
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