=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114058534
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARAGON HEMOPHILIA SOLUTIONS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2007
-----------------------------------------------------
Last Update Date | 11/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3033 W PRESIDENT GEORGE BUSH HWY STE 100B
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75075-5752
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-588-1072
-----------------------------------------------------
Fax | 866-388-1488
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3033 W PRESIDENT GEORGE BUSH HWY STE 100-B
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75075-5752
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-588-1000
-----------------------------------------------------
Fax | 866-388-1488
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | AMY MULDERRY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 972-588-1000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336H0001X
-----------------------------------------------------
Taxonomy Name | Home Infusion Therapy Pharmacy
-----------------------------------------------------
License Number | 25453
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336S0011X
-----------------------------------------------------
Taxonomy Name | Specialty Pharmacy
-----------------------------------------------------
License Number | 25453
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------