1558600593 NPI number — GRAND SPECIALTY PHARMACY

Table of content: (NPI 1558600593)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558600593 NPI number — GRAND SPECIALTY PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRAND SPECIALTY PHARMACY
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:
TPCRX INC
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:
1558600593
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1513 S GRAND AVE STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90015-3075
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
213-747-3200
Provider Business Mailing Address Fax Number:
213-747-3201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1513 S GRAND AVE STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90015-3075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-747-3200
Provider Business Practice Location Address Fax Number:
213-747-3201
Provider Enumeration Date:
02/12/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BEHEL
Authorized Official First Name:
ARMIN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO/PIC
Authorized Official Telephone Number:
213-747-3200

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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