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General NPI Number Information
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NPI Number | 1417821307
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Entity Type | Organization
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Legal Business Name | ST JUDE SPECIALTY CARE INC.
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Dates
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Enumeration Date | 10/02/2025
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 13916 LEXINGTON BLVD
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City | SUGAR LAND
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State | TX
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Zip | 77478-5362
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Country | US
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Telephone | 281-715-7110
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Fax | 281-715-7110
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Provider Business Mailing Address
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Address Line | 13916 LEXINGTON BLVD
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City | SUGAR LAND
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State | TX
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Zip | 77478-5362
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Country | US
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Telephone | 281-715-7110
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Fax | 281-715-7110
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DR. GLORIA EGBUCHUNAM
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Credential | PHARMD, RPH
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Telephone | 281-715-7110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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