1457532590 NPI number — SPECIALTY PHARMACIES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457532590 NPI number — SPECIALTY PHARMACIES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPECIALTY PHARMACIES, INC.
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:
1457532590
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
45 MELVILLE PARK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MELVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11747-3109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-547-6531
Provider Business Mailing Address Fax Number:
631-547-6532

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
465 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94607-3839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-835-0774
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FICHERA
Authorized Official First Name:
RUSSELL
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
SENIOR VICE PRESIDENT AND TREASURER
Authorized Official Telephone Number:
508-297-1018

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5628803 . This is a "NCPDP" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: PHY 50166 . This is a "STATE LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: PHA 50166 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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