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General NPI Number Information
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NPI Number | 1285052332
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Entity Type | Organization
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Legal Business Name | CUSTOMIZED MEDICINE CONSULTANTS
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Dates
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Enumeration Date | 04/04/2014
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Last Update Date | 04/04/2014
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Provider Practice Location Address
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Address Line | 3971 WILD LIME LN
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-6005
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Country | US
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Telephone | 954-892-1877
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Fax |
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Provider Business Mailing Address
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Address Line | 3971 WILD LIME LN
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-6005
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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 | MANAGING MEMBER
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Name | SUZETTE WOOD
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Credential |
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Telephone | 954-892-1877
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number |
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License Number State |
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