Provider Demographics
NPI:1558417691
Name:CUSTOM MEDS, INC.
Entity Type:Organization
Organization Name:CUSTOM MEDS, INC.
Other - Org Name:MCCULLY SNYDER PHARMACY, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:DILEO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:352-341-1212
Mailing Address - Street 1:102 E. HIGHLAND BLVD.
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452
Mailing Address - Country:US
Mailing Address - Phone:352-341-1212
Mailing Address - Fax:352-341-2626
Practice Address - Street 1:102 E. HIGHLAND BLVD.
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452
Practice Address - Country:US
Practice Address - Phone:352-341-1212
Practice Address - Fax:352-341-2626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH 128473336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy