MEDICARE: CUSTOM CARE PHARMACY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0004X	Compounding Pharmacy
4	3336C0003X	Community/Retail Pharmacy	31300	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	7656600001	OTHER	DME POS
3	2166614	OTHER	PK

General Provider Information

NPI Number	:	1861935389
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CUSTOM CARE PHARMACY LLC

Provider Business Mailing Address
First Line	:	20320 NORTHWEST FWY STE 300
Second Line	:	SUITE#300
City	:	JERSEY VILLAGE
State	:	TX
Zip	:	77065-5643
Country	:	US
Telephone Number	:	832-688-9666
Fax Number	:	832-604-7291

Provider Business Practice Location Address
First Line	:	20320 NORTHWEST FWY STE 300
Second Line	:
City	:	JERSEY VILLAGE
State	:	TX
Zip	:	77065-5643
Country	:	US
Telephone Number	:	832-688-9666
Fax Number	:	832-604-7291

Authorized Official
Title or Position	:	PHARMACIST
Name	:	CARMALITA LANDRY
Credential	:
Telephone Number	:	832-508-4799

Provider Enumeration Date	:	12/01/2016
Last Update Date	:	09/19/2025

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Directions to “CUSTOM CARE PHARMACY LLC ” Practice Location

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