Healthcare Provider Details

I. General information

NPI: 1043524317
Provider Name (Legal Business Name): PHARMACEUTICAL SPECIALTIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2010
Last Update Date: 06/24/2022
Certification Date: 06/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 W KING ST # LL20
KINGS MOUNTAIN NC
28086-3362
US

IV. Provider business mailing address

PO BOX 1353
AMARILLO TX
79105-1353
US

V. Phone/Fax

Practice location:
  • Phone: 800-818-6486
  • Fax: 980-613-4324
Mailing address:
  • Phone: 806-242-7782
  • Fax: 980-613-4324

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 Number13118
License Number StateNC

VIII. Authorized Official

Name: RYAN ATKINSON
Title or Position: SR. DIR. PHARMACY PAYOR CONTRACTING
Credential:
Phone: 806-242-7782