Healthcare Provider Details

I. General information

NPI: 1902949068
Provider Name (Legal Business Name): CUSTOM PHARMACY SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2637 VALLEYDALE RD
HOOVER AL
35244-2075
US

IV. Provider business mailing address

2637 VALLEYDALE RD
HOOVER AL
35244-2075
US

V. Phone/Fax

Practice location:
  • Phone: 205-988-3383
  • Fax: 202-988-3553
Mailing address:
  • Phone: 205-988-3383
  • Fax: 205-988-3553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number112911
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LAURIE DICKINSON
Title or Position: PHARMACIST IN CHARGE
Credential: PHARM.D.
Phone: 205-988-3383