Healthcare Provider Details

I. General information

NPI: 1659623791
Provider Name (Legal Business Name): CUSTOM CHEMISTS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2012
Last Update Date: 04/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 AVENUE J
BROOKLYN NY
11230-3702
US

IV. Provider business mailing address

1408 AVENUE J
BROOKLYN NY
11230-3702
US

V. Phone/Fax

Practice location:
  • Phone: 718-677-8500
  • Fax: 718-677-8501
Mailing address:
  • Phone: 718-677-8500
  • Fax: 718-677-8501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID ZEEMAN KUNIN
Title or Position: PRESIDENT
Credential: PHARM. D.
Phone: 718-677-8500