Provider Demographics
NPI:1003112079
Name:SPECIALTY RX INC
Entity Type:Organization
Organization Name:SPECIALTY RX INC
Other - Org Name:SPECIALTY RX INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUPNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-241-6337
Mailing Address - Street 1:209 E 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07203-2015
Mailing Address - Country:US
Mailing Address - Phone:908-241-6337
Mailing Address - Fax:908-241-4034
Practice Address - Street 1:209 E 11TH AVE
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:NJ
Practice Address - Zip Code:07203-2015
Practice Address - Country:US
Practice Address - Phone:908-241-6337
Practice Address - Fax:908-241-4034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
NJ28RS006297003336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3197628OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NJ0025089Medicaid
NY02577315Medicaid