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General NPI Number Information
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NPI Number | 1215636485
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Entity Type | Organization
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Legal Business Name | CUSTOM CARE RX LLC
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Dates
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Enumeration Date | 02/27/2023
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Last Update Date | 02/27/2023
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Provider Practice Location Address
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Address Line | 7900 FANNIN ST STE 1480
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City | HOUSTON
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State | TX
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Zip | 77054-2946
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Country | US
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Telephone | 714-717-7247
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Fax |
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Provider Business Mailing Address
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Address Line | 412 OLIVE AVE # 535
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92648-5142
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER DZIOBA
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Credential |
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Telephone | 714-717-7247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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