MEDICARE: SPECIALTY PHARMA SAI INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	5674812	OTHER		NCPDP
3	PHY58096	OTHER	CA	CALIFORNIA BOARD OF PHARMACY

General Provider Information

NPI Number	:	1386226306
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECIALTY PHARMA SAI INC

Provider Business Mailing Address
First Line	:	15642 SAND CANYON AVE UNIT 53871
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92619-5430
Country	:	US
Telephone Number	:	949-590-0056
Fax Number	:	619-333-2525

Provider Business Practice Location Address
First Line	:	4153B UNIVERSITY AVE, SUITE B
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92105-1421
Country	:	US
Telephone Number	:	949-590-0056
Fax Number	:	619-333-2525

Authorized Official
Title or Position	:	PRESIDENT
Name	:	VIJAYA LAXMI
Credential	:
Telephone Number	:	949-590-0056

Provider Enumeration Date	:	04/28/2021
Last Update Date	:	04/29/2022

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Directions to “SPECIALTY PHARMA SAI INC ” Practice Location

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