Organization
CUSTOM RX LLC
Active
Parent organization
CUSTOM RX LLC
Other names
Custom Rx Pharmacy Melba
Organization subpart
Yes
Provider details
NPI number
Legal business name
CUSTOM RX LLC
Authorized official
TRAVIS WALTHALL RPH (PIC/MANAGING MEMBER)
(208) 922-4400
Entity
Organization
Contact information
Practice address
112 4TH ST, MELBA, ID 83641-5197
(208) 495-9809
Mailing address
PO BOX 246, KUNA, ID 83634-0246
(208) 922-4400
(208) 922-4499
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
10/17/2018
Last updated
10/17/2018
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up