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General NPI Number Information
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NPI Number | 1346105228
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Entity Type | Organization
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Legal Business Name | CUSTOM IVY INC
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Dates
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Enumeration Date | 12/22/2025
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Last Update Date | 12/22/2025
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Provider Practice Location Address
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Address Line | 72 ARGONAUT STE 130
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City | ALISO VIEJO
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State | CA
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Zip | 92656-4144
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Country | US
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Telephone | 949-520-6864
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Fax |
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Provider Business Mailing Address
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Address Line | 72 ARGONAUT STE 130
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City | ALISO VIEJO
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State | CA
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Zip | 92656-4144
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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 | CEO/CFO/SEC.
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Name | GREG WARE
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Credential |
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Telephone | 949-615-6534
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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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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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