Provider Demographics
NPI:1053415380
Name:PEOPLE'S CUSTOM RX & CLINICAL CARE CENTER, LLC
Entity type:Organization
Organization Name:PEOPLE'S CUSTOM RX & CLINICAL CARE CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:SHAWN
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:901-682-2273
Mailing Address - Street 1:785 E BROOKHAVEN CIRCLE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-4501
Mailing Address - Country:US
Mailing Address - Phone:901-682-2273
Mailing Address - Fax:901-682-4146
Practice Address - Street 1:785 E BROOKHAVEN CIRCLE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4501
Practice Address - Country:US
Practice Address - Phone:901-682-2273
Practice Address - Fax:901-682-4146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN32573336C0003X, 3336C0004X
3336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN37715OtherINTERNATIONAL JOURNAL OF COMPOUNDING TODAY
TN4431728OtherNCPDP
TN1154791OtherNATIONAL COMMUNITY PHARM ASSOCIATION
TNQ045733Medicaid
TN47541OtherINTERNATIONAL JOURNAL OF COMPOUNDING PHARMACIST STAND -
TN700497OtherAMERICAN PHARMACISTS ASSOCIATION
TN1154791OtherNATIONAL COMMUNITY PHARM ASSOCIATION