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General NPI Number Information
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NPI Number | 1083099485
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Entity Type | Organization
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Legal Business Name | PARAGON SPECIALTY PHARMACY, LLC
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Dates
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Enumeration Date | 07/27/2015
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Last Update Date | 11/29/2016
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Provider Practice Location Address
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Address Line | 2920 MOTLEY DR SUITE 800
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City | MESQUITE
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State | TX
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Zip | 75150
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Country | US
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Telephone | 855-355-3552
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Fax | 855-355-3554
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Provider Business Mailing Address
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Address Line | 2920 MOTLEY DR SUITE 800
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City | MESQUITE
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State | TX
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Zip | 75150
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Country | US
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Telephone | 855-355-3552
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Fax | 855-355-3554
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Authorized Official
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Title or Position | OFFICER
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Name | ULFAT U NISA
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Credential | RPH
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Telephone | 855-355-3552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 30072
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License Number State | TX
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