MEDICARE: SPECIALIZED PHARMACY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	18791	TX
2	3336M0002X	Mail Order Pharmacy
3	3336L0003X	Long Term Care Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4593895	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1306882774
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECIALIZED PHARMACY, INC.

Provider Business Mailing Address
First Line	:	15401 VANTAGE PKWY W
Second Line	:	SUITE 120
City	:	HOUSTON
State	:	TX
Zip	:	77032-1968
Country	:	US
Telephone Number	:	281-987-8500
Fax Number	:	281-987-2660

Provider Business Practice Location Address
First Line	:	15401 VANTAGE PKWY W
Second Line	:	SUITE 120
City	:	HOUSTON
State	:	TX
Zip	:	77032-1968
Country	:	US
Telephone Number	:	281-987-8500
Fax Number	:	281-987-2660

Authorized Official
Title or Position	:	PHARMACIST IN CHARGE
Name	:	STANLEY LEE
Credential	:
Telephone Number	:	281-987-8500

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	03/15/2011

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Directions to “SPECIALIZED PHARMACY, INC. ” Practice Location

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