Organization
CUSTOM MED, LLC
Active
Parent organization
CUSTOM MED LLC
Other names
Prime Plus Lakeview
Organization subpart
Yes
Provider details
NPI number
Legal business name
CUSTOM MED LLC
Authorized official
INAS DAHABRA (MEMBER, PRESIDENT)
(708) 289-6721
Entity
Organization
Contact information
Practice address
3156 N. CLARK, CHICAGO, IL 60657
(773) 568-8340
Mailing address
3156 N. CLARK, CHICAGO, IL 60657
(708) 289-6721
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
03/26/2024
Last updated
10/02/2024
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