Healthcare Provider Details

I. General information

NPI: 1073606240
Provider Name (Legal Business Name): CUSTOM PHARMACY INNOVATIONS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10911 NE 23RD
NICOMA PARK OK
73066
US

IV. Provider business mailing address

PO BOX 489
NICOMA PARK OK
73066-0489
US

V. Phone/Fax

Practice location:
  • Phone: 405-769-8585
  • Fax: 405-769-8787
Mailing address:
  • Phone: 405-769-8585
  • Fax: 405-769-8787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number18135
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: FARHANA KABIR
Title or Position: MANAGING OWNER
Credential:
Phone: 405-769-8585