Provider Demographics
NPI:1659623791
Name:CUSTOM CHEMISTS INC.
Entity Type:Organization
Organization Name:CUSTOM CHEMISTS INC.
Other - Org Name:DAVID'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ZEEMAN
Authorized Official - Last Name:KUNIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:718-677-8500
Mailing Address - Street 1:1408 AVENUE J
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-3702
Mailing Address - Country:US
Mailing Address - Phone:718-677-8500
Mailing Address - Fax:718-677-8501
Practice Address - Street 1:1408 AVENUE J
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-3702
Practice Address - Country:US
Practice Address - Phone:718-677-8500
Practice Address - Fax:718-677-8501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-13
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6726280001Medicare NSC