Provider Demographics
NPI:1508298175
Name:CUSTOM APOTHECARY SOLUTIONS
Entity Type:Organization
Organization Name:CUSTOM APOTHECARY SOLUTIONS
Other - Org Name:CAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VONDA
Authorized Official - Middle Name:ROSETTA
Authorized Official - Last Name:WALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-416-6925
Mailing Address - Street 1:2817 RED OAK LN
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-1073
Mailing Address - Country:US
Mailing Address - Phone:713-416-6325
Mailing Address - Fax:
Practice Address - Street 1:2817 RED OAK LN
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-1073
Practice Address - Country:US
Practice Address - Phone:713-416-6325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy