Provider Demographics
NPI:1003158205
Name:SPECIALTY RX
Entity Type:Organization
Organization Name:SPECIALTY RX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-416-1648
Mailing Address - Street 1:980 ENCHANTED WAY STE 211
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-0914
Mailing Address - Country:US
Mailing Address - Phone:805-416-1648
Mailing Address - Fax:805-823-6519
Practice Address - Street 1:980 ENCHANTED WAY STE 211
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-0914
Practice Address - Country:US
Practice Address - Phone:805-416-1648
Practice Address - Fax:805-823-6519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty