Organization
CUSTOM HEALTHCARE
Active
Other names
PPS Infusion Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
WANDA S KEY RN (PRESIDENT OF OPERATIONS)
(423) 697-0057
Entity
Organization
Contact information
Practice address
6227 LEE HIGHWAY, SUITE I, CHATTANOOGA, TN 37421
(423) 893-9335
(423) 893-9336
Mailing address
3700 BRAINERD RD, CHATTANOOGA, TN 37411-3603
(423) 697-0057
Taxonomy
Speciality
Code
Description
License number
State
251F00000X
Home Infusion Agency
Primary
73387
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1452932
—
TN
Enumeration date
11/15/2006
Last updated
03/08/2019
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