Healthcare Provider Details

I. General information

NPI: 1265464705
Provider Name (Legal Business Name): PHARMACEUTICAL SPECIALTIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 09/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 CLEVELAND RD STE A
BOGART GA
30622-1701
US

IV. Provider business mailing address

320 S POLK ST STE 800
AMARILLO TX
79101-1429
US

V. Phone/Fax

Practice location:
  • Phone: 706-369-9591
  • Fax: 706-369-9698
Mailing address:
  • Phone: 806-242-7782
  • Fax: 806-324-5495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHHH000064
License Number StateGA

VIII. Authorized Official

Name: ROSS HALSNE
Title or Position: VICE PRESIDENT-MARKET STRATEGY
Credential:
Phone: 806-242-7782