Customedica Pharmacy Inc
NPI 1508162454ActiveOrganization· Pharmacy, Compounding Pharmacy· Eagle, ID
Pharmacy, Compounding Pharmacy in Eagle, Idaho, registered in NPPES in February 2011. The authorized official on file is Shah Afshar, PHARM.D., Cheif Pharmacist.
Overview
| NPI | 1508162454 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Feb 9, 2011 |
| Last updated in NPPES | Aug 17, 2016 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Pharmacy, Compounding Pharmacy Primary | 3336C0004X | 1651RP | ID |
| Pharmacy | 333600000X | — | — |
| Pharmacy, Community/Retail Pharmacy | 3336C0003X | — | — |
| Pharmacy, Specialty Pharmacy | 3336S0011X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
Other Pharmacy, Compounding Pharmacy providers in Eagle
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