Provider Demographics
NPI:1538140991
Name:CUSTIS, JEFFREY J (RPH)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:J
Last Name:CUSTIS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3293 LINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45226-1267
Mailing Address - Country:US
Mailing Address - Phone:513-321-8216
Mailing Address - Fax:
Practice Address - Street 1:9844 WINDISCH RD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-3806
Practice Address - Country:US
Practice Address - Phone:513-759-2818
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03209269183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist