Healthcare Provider Details

I. General information

NPI: 1053186791
Provider Name (Legal Business Name): POLARIS SPECIALTY PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2023
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

837 W ARROW HWY
GLENDORA CA
91740-5413
US

IV. Provider business mailing address

2900 NW 60TH ST
FORT LAUDERDALE FL
33309-1774
US

V. Phone/Fax

Practice location:
  • Phone: 626-962-1061
  • Fax:
Mailing address:
  • Phone: 800-589-9747
  • Fax: 954-923-9261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: REGINA HUNT
Title or Position: CORPORATE DIRECTOR OF COMPLIANCE, C
Credential:
Phone: 800-589-9747