Organization
CUSTOMIZED MEDICATION, LLC
Active
Organization
CUSTOMIZED MEDICATION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD SARGENT (OWNER)
(574) 522-1940
Entity
Organization
Contact information
Practice address
541 ROSKE DR STE E, ELKHART, IN 46516-9323
(574) 522-1940
(574) 522-1990
Mailing address
58147 DIENER DR, GOSHEN, IN 46528-7723
(574) 522-1940
(574) 522-1990
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
60005663A
IN
Other
Enumeration date
06/21/2008
Last updated
04/24/2013
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