Organization
CUSTOM RX INC
Active
Other names
CUSTOM RX PHARMACY & WELLNESS CONCEPTS
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICHOLAS L BRANAM PHARM.D. (PHARMACIST IN CHARGE)
(316) 721-2626
Entity
Organization
Contact information
Practice address
3510 N RIDGE RD STE 900, WICHITA, KS 67205-1225
(316) 721-2626
(316) 721-4823
Mailing address
3510 N RIDGE RD STE 900, WICHITA, KS 67205-1225
(316) 721-2626
(316) 721-4823
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
054.019573
IL
3336C0004X
Compounding Pharmacy
13708
NC
3336C0004X
Compounding Pharmacy
2012019217
MO
3336C0004X
Compounding Pharmacy
209867
KS
3336C0004X
Compounding Pharmacy
264830
MN
3336C0004X
Compounding Pharmacy
44645MS
ID
3336C0004X
Compounding Pharmacy
4477
IA
3336C0004X
Compounding Pharmacy
64001361A
IN
3336C0004X
Compounding Pharmacy
758
NE
3336C0004X
Compounding Pharmacy
Primary
OS02495
AR
3336C0004X
Compounding Pharmacy
PH00004390
NM
3336C0004X
Compounding Pharmacy
PH02874
NV
3336C0004X
Compounding Pharmacy
PH17904
FL
3336C0004X
Compounding Pharmacy
PHAR1497
ND
3336C0004X
Compounding Pharmacy
PHNR000914
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100445230C
—
KS
01
—
2027079
PK
—
Enumeration date
09/12/2006
Last updated
07/12/2023
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