Healthcare Provider Details

I. General information

NPI: 1740101807
Provider Name (Legal Business Name): CUSTOM PHARMACY INNOVATIONS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10911 NE 23RD ST
OKLAHOMA CITY OK
73141-6029
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 TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

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