NPI 1790925725

Custom Rx, PC

Organisation Compounding Pharmacy Broken Bow, NE

Practice location

Address: 540 S 8th Ave STE B, Broken Bow, NE 68822-2456
Phone: (308) 872-5602
Fax: (308) 872-2377

Authorised official

Name: Mike D. Holcomb
Title: Pharmacist/Owner
Phone: (308) 872-5602

Registered specialties

Compounding Pharmacy Primary

Suppliers Taxonomy 3336C0004X Licence 2818 (NE)

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Registry record

NPI: 1790925725
Entity type: Organization
NPI issued: 3 Mar 2009
Record last updated: 3 Mar 2009

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.