Provider Demographics
NPI:1144749979
Name:CUSTOM CARE PHARMACY
Entity Type:Organization
Organization Name:CUSTOM CARE PHARMACY
Other - Org Name:CUSTOM CARE PHARMACY SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:570-246-5700
Mailing Address - Street 1:59 S FRONT ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:PA
Mailing Address - Zip Code:17847-1110
Mailing Address - Country:US
Mailing Address - Phone:570-246-5700
Mailing Address - Fax:570-742-7500
Practice Address - Street 1:59 S FRONT ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:PA
Practice Address - Zip Code:17847-1110
Practice Address - Country:US
Practice Address - Phone:570-246-5700
Practice Address - Fax:570-742-7500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy