1508123969 NPI number — SPECIALTY PHARMACEUTICAL SOLUTIONS, LLC

Table of content: (NPI 1508123969)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508123969 NPI number — SPECIALTY PHARMACEUTICAL SOLUTIONS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPECIALTY PHARMACEUTICAL SOLUTIONS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GULF COAST PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508123969
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1838 ELM HILL PIKE
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37210-3726
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-567-3432
Provider Business Mailing Address Fax Number:
888-208-1097

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6550 MAPLERIDGE ST
Provider Second Line Business Practice Location Address:
SUITE 222
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77081-4600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-567-3432
Provider Business Practice Location Address Fax Number:
888-208-1097
Provider Enumeration Date:
04/23/2012

Additional Information

Authorized Official

Authorized Official Last Name:
FOWLER
Authorized Official First Name:
CLINT
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
281-851-7506

Provider Taxonomy Codes

  • Taxonomy code: 3336S0011X , with the licence number:  27893 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com