Organization
CUSTOM MADE PHARMACY INC
Active
Other names
SPECIALITY COMPOUNDING PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID KOHANJASH (SECRETARY)
(818) 308-8314
Entity
Organization
Contact information
Practice address
13322 RIVERSIDE DR, SHERMAN OAKS, CA 91423-2509
(818) 789-8111
(818) 789-6548
Mailing address
13322 RIVERSIDE DR, SHERMAN OAKS, CA 91423-2509
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
48534
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5626289
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
03/09/2007
Last updated
02/11/2009
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