Provider Demographics
NPI:1851005722
Name:CUSTOM MED INC.
Entity Type:Organization
Organization Name:CUSTOM MED INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:NADERA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABU MAHFOUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-523-4310
Mailing Address - Street 1:23965 NOVI RD STE 100
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-3232
Mailing Address - Country:US
Mailing Address - Phone:317-340-1245
Mailing Address - Fax:
Practice Address - Street 1:23965 NOVI RD STE 100
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-3232
Practice Address - Country:US
Practice Address - Phone:317-340-1245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
-Other-