Healthcare Provider Details

I. General information

NPI: 1871914473
Provider Name (Legal Business Name): SPECIALTY PHARMACY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2013
Last Update Date: 05/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 W MAIN ST STE 7
MOUNT PLEASANT PA
15666-1533
US

IV. Provider business mailing address

445 W MAIN ST STE 7
MOUNT PLEASANT PA
15666-1533
US

V. Phone/Fax

Practice location:
  • Phone: 724-547-1989
  • Fax: 724-542-4148
Mailing address:
  • Phone: 724-547-1989
  • Fax: 724-542-4148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License NumberPP481684
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2143546
Identifier TypeOTHER
Identifier State
Identifier IssuerPK

VIII. Authorized Official

Name: JOSEPH MESHANSKI
Title or Position: MEMBER
Credential:
Phone: 724-547-1989