Organization
CUSTOM MED APOTHECARY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFF JACKSON R.PH. (MEMBER)
(317) 803-3436
Entity
Organization
Contact information
Practice address
5510 LAFAYETTE RD, SUITE 260, INDIANAPOLIS, IN 46254-1685
(317) 803-3436
(317) 803-3437
Mailing address
5510 LAFAYETTE RD, SUITE 260, INDIANAPOLIS, IN 46254-1685
(317) 803-3436
(317) 803-3437
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
60005496A
IN
Other
Enumeration date
05/21/2007
Last updated
08/22/2020
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