Provider Demographics
NPI:1346209863
Name:CUSTOM MEDS INC
Entity Type:Organization
Organization Name:CUSTOM MEDS INC
Other - Org Name:CUSTOM MEDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT RPH
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:AARON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-332-3022
Mailing Address - Street 1:104 MONTGOMERY ST SW
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35653
Mailing Address - Country:US
Mailing Address - Phone:256-332-3022
Mailing Address - Fax:256-332-3036
Practice Address - Street 1:104 MONTGOMERY ST SW
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653
Practice Address - Country:US
Practice Address - Phone:256-332-3022
Practice Address - Fax:256-332-3036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty