Provider Demographics
NPI:1962055186
Name:CUSTOM DOSING EAST
Entity type:Organization
Organization Name:CUSTOM DOSING EAST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TECH/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAUDILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-487-1879
Mailing Address - Street 1:4319 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-7806
Mailing Address - Country:US
Mailing Address - Phone:219-221-6958
Mailing Address - Fax:219-221-6947
Practice Address - Street 1:4319 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-7806
Practice Address - Country:US
Practice Address - Phone:219-221-6958
Practice Address - Fax:219-221-6947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy