MEDICARE: SURECARE SPECIALTY PHARMACY, LLC

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	3336C0004X	Compounding Pharmacy
2	3336S0011X	Specialty Pharmacy	29220	TX
3	3336C0003X	Community/Retail Pharmacy	29220	TX

General Provider Information

NPI Number	:	1760815211
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURECARE SPECIALTY PHARMACY, LLC

Provider Business Mailing Address
First Line	:	4005 N MESA ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902-1526
Country	:	US
Telephone Number	:	855-532-2400
Fax Number	:

Provider Business Practice Location Address
First Line	:	4005 N MESA ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902-1526
Country	:	US
Telephone Number	:	855-532-2400
Fax Number	:

Authorized Official
Title or Position	:	PIC
Name	:	ALEXANDRA TORRES
Credential	:	PHARMD
Telephone Number	:	915-532-2400

Provider Enumeration Date	:	08/19/2013
Last Update Date	:	03/19/2024

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