Organization
CUSTOM PRESCRIPTION SHOPPE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN FARIS (CEO)
(360) 685-4282
Entity
Organization
Contact information
Practice address
5917 PORTAL WAY, FERNDALE, WA 98248-9361
(360) 685-4282
Mailing address
5917 PORTAL WAY, FERNDALE, WA 98248-9361
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
CF00057668
WA
3336M0002X
Mail Order Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4930550
OTHER ID NUMBER
—
05
—
6026835
—
WA
Enumeration date
11/03/2006
Last updated
08/01/2024
About Stedi
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