1265464705 NPI number — PHARMACEUTICAL SPECIALTIES LLC

Table of content: (NPI 1265464705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265464705 NPI number — PHARMACEUTICAL SPECIALTIES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHARMACEUTICAL SPECIALTIES 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:
Provider Other Organization Name Type Code:
6
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:
1265464705
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 S POLK ST STE 800
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMARILLO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79101-1429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-242-7782
Provider Business Mailing Address Fax Number:
806-324-5495

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 CLEVELAND RD
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
BOGART
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30622-1701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-369-9591
Provider Business Practice Location Address Fax Number:
706-369-9698
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HALSNE
Authorized Official First Name:
ROSS
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT-MARKET STRATEGY
Authorized Official Telephone Number:
806-242-7782

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PHHH000064 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 00710542B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00710542A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2019543 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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