Customedica Pharmacy Inc
Customedica Pharmacy Inc is a healthcare organization registered as Compounding Pharmacy in Eagle, ID, holding Type 2 (organization) NPI 1508162454 since 2011. The authorized official on file is Shah Afshar, Cheif Pharmacist.
✓ Active NPI ✓ Valid NPI checksum
| NPI | 1508162454 |
|---|---|
| Entity type | Organization (Type 2) |
| Legal business name | Customedica Pharmacy Inc |
| Other name | <Unavail> |
| Practice address | 149 W STATE ST STE 101, Eagle, ID, 83616 |
| Phone | 2089398008 |
| Fax | 2089381067 |
| Enumeration date | 2011-02-09 |
| Last updated in NPPES | 2016-08-17 |
Authorized official
| Name | Shah Afshar |
|---|---|
| Title | Cheif Pharmacist |
| Phone | 2089398008 |
Taxonomy & classification
| Taxonomy code | Specialty | Primary | License | State |
|---|---|---|---|---|
| 333600000X | Pharmacy | Secondary | — | — |
| 3336C0003X | Community/Retail Pharmacy | Secondary | — | — |
| 3336S0011X | Specialty Pharmacy | Secondary | — | — |
| 3336C0004X | Compounding Pharmacy | Primary | 1651RP | ID |
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2128455 | Other | — | PK |
| 806251800 | Medicaid | ID | — |
Copy-ready billing details
Provider: Customedica Pharmacy Inc NPI: 1508162454 Taxonomy: 3336C0004X (Compounding Pharmacy) Address: 149 W STATE ST STE 101, Eagle, ID, 83616
Providers at this address
| NPI | Name | Type | Specialty | Location |
|---|---|---|---|---|
| 1780729988 | Customedica Pharmacy Inc | Organization | Community/Retail Pharmacy | Eagle, ID |
| 1295101400 | Alex Wald | Individual | Pharmacist | Eagle, ID |
| 1447710728 | Alyssa Zibrowski | Individual | Pharmacist | Eagle, ID |
Verify this record
Cross-check NPI 1508162454 against the authoritative CMS record: view Customedica Pharmacy Inc on the official NPPES registry .
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes — even if the provider moves or changes specialty. Read the full guide or validate an NPI number.
Frequently asked questions
What is a Type 2 NPI?
What type of organization is Customedica Pharmacy Inc?
Source: CMS NPPES (public data). Snapshot 2026-07-11. Provider record last updated 2016-08-17.