Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Customedica Pharmacy Inc

Organization Pharmacy · NPI 1508162454

Customedica Pharmacy Inc is a Pharmacy in Eagle, Idaho. Licensed in Idaho. Registered with an NPI since 2011.

Licensed in
ID
In the registry since
2011
Specialties on file
4
What do these letters mean?
Inc — Incorporated
A form of business registration, not a clinical qualification.

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Practice location Address checks out

149 W State St Ste 101
Eagle, ID 83616-4911
Phone: (208) 939-8008
Fax: (208) 938-1067
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Compounding Pharmacy (primary) Taxonomy 3336C0004X · Licence 1651RP (ID)
Pharmacy Taxonomy 333600000X
Community/Retail Pharmacy Taxonomy 3336C0003X
Specialty Pharmacy Taxonomy 3336S0011X

Record details

NPI number1508162454
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Shah Afshar — Cheif Pharmacist · (208) 939-8008
Other names Customedica Compounding Center
NPI enumeratedFebruary 9, 2011
Last updated in NPPESAugust 17, 2016
Mailing address149 W State St, Suite 101, Eagle, ID 83616-4901

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