Organization
CUSTOM COMPOUNDING CENTERS LLC
Active
Other names
CUSTOM COMPOUNDING CENTERS
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL WHEELER (PIC)
(714) 824-2120
Entity
Organization
Contact information
Practice address
10525 HUMBOLT ST, LOS ALAMITOS, CA 90720-5401
(714) 894-2120
(714) 894-2150
Mailing address
10525 HUMBOLT ST, LOS ALAMITOS, CA 90720-5401
(714) 894-2120
(714) 894-2150
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
Primary
PHY 50368
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0590388
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
02/17/2010
Last updated
01/14/2014
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