=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760862247
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTHCARE SPECIALTY TRANSACTIONS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2015
-----------------------------------------------------
Last Update Date | 06/01/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1267 PROFESSIONAL PKWY STE 200
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30507-8705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 844-375-3003
-----------------------------------------------------
Fax | 844-375-3004
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1267 PROFESSIONAL PKWY SUITE 200
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30507-8705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 844-375-3003
-----------------------------------------------------
Fax | 844-375-3004
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF PHARMACY OFFICER
-----------------------------------------------------
Name | MICHAEL ROSE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 800-662-0586
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PHRE010152
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------