MEDICARE: AMERICAN SPECIALTY 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
2	3336C0003X	Community/Retail Pharmacy	30569	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2158028	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962861336
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN SPECIALTY PHARMACY INC

Provider Business Mailing Address
First Line	:	13988 DIPLOMAT DR STE 100
Second Line	:
City	:	FARMERS BRANCH
State	:	TX
Zip	:	75234-8831
Country	:	US
Telephone Number	:	214-919-2520
Fax Number	:	214-919-2524

Provider Business Practice Location Address
First Line	:	1210 COTTONWOOD CREEK TRL STE 210
Second Line	:
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-2688
Country	:	US
Telephone Number	:	512-649-5425
Fax Number	:	512-649-5436

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ABDUL HAMEED
Credential	:
Telephone Number	:	214-919-2520

Provider Enumeration Date	:	02/15/2016
Last Update Date	:	04/27/2023

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