Healthcare Provider Details

I. General information

NPI: 1396288338
Provider Name (Legal Business Name): CLINICAL SPECIALTY INFUSIONS OF DALLAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2016
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 E NEW BOSTON RD
NASH TX
75569-2715
US

IV. Provider business mailing address

459 E NEW BOSTON RD
NASH TX
75569-2715
US

V. Phone/Fax

Practice location:
  • Phone: 833-569-1005
  • Fax: 430-200-4889
Mailing address:
  • Phone: 833-569-1005
  • Fax: 430-200-4870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number31100
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License NumberPH00004457
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number054020523
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License NumberNR-51359
License Number StateWY
# 5
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberA9-0002021
License Number StateDE
# 8
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberY007261
License Number StateAZ
# 9
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number64002405A
License Number StateIN
# 10
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License NumberOSP.0006979
License Number StateCO
# 11
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 12
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License NumberOSO2790
License Number StateAR

VIII. Authorized Official

Name: JAMES LYNN SHEETS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: PHARM.D.
Phone: 833-569-1005