Organization
CUSTOM CARE PHARMACY, LLC
Active
Other names
Custom Care Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MARCO MORAN (PHARMICIST-IN-CHARGE)
(318) 791-3765
Entity
Organization
Contact information
Practice address
132 E NORTHSIDE DR, SUITE C, CLINTON, MS 39056-3415
(601) 488-4360
(877) 747-5326
Mailing address
132 E NORTHSIDE DR, SUITE C, CLINTON, MS 39056-3415
(601) 488-4360
(877) 747-5326
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
07892/2.2
MS
3336C0004X
Compounding Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2143363
PK
—
Enumeration date
12/12/2013
Last updated
12/12/2013
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