Organization · NPI-2

Customized Medication, LLC

Clinic/Center · Elkhart, IN

NPI number1497916548
StatusActive
Last updated in NPPESApr 24, 2013

Details

NPI
1497916548
Entity type
Organization (NPI-2)
Legal business name
Customized Medication, LLC
Organization subpart
No
Enumeration date
Jun 21, 2008
Last updated
Apr 24, 2013

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261Q00000X Clinic/Center60005663AINYes

Practice location

541 Roske Dr Ste E
Elkhart, IN 46516-9323

Phone 574-522-1940 · Fax 574-522-1990

Mailing address

58147 Diener Dr
Goshen, IN 46528-7723

Phone 574-522-1940 · Fax 574-522-1990

Authorized official

Richard Sargent
Owner
5745221940

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