1730220468 NPI number — SPECTRUM PHARMACY SERVICES LLC

Table of content: (NPI 1730220468)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730220468 NPI number — SPECTRUM PHARMACY SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPECTRUM PHARMACY SERVICES 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:
PHARMERICA
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:
1730220468
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3802 CORPOREX PARK DR.
Provider Second Line Business Mailing Address:
STE 150
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33619-1125
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-318-6039
Provider Business Mailing Address Fax Number:
800-825-6408

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4750 LONGLEY LN STE 204
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RENO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89502-5982
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-825-6117
Provider Business Practice Location Address Fax Number:
775-825-3840
Provider Enumeration Date:
02/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
ALLISON
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
502-630-7429

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X , with the licence number:  PH02018 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: PHC02018 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1730220468 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: NRP2563 . This is a "BOARD OF PHARMACY" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 2989032 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: PHC02018 . This is a "BOARD OF PHARMACY" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 1730220468 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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