Provider Demographics
NPI:1003433376
Name:MAXOR NATIONAL PHARMACY SERVICES LLC
Entity Type:Organization
Organization Name:MAXOR NATIONAL PHARMACY SERVICES LLC
Other - Org Name:MAXOR SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. DIR. PHARMACY PAYOR CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ATKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-242-7782
Mailing Address - Street 1:PO BOX 9432
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79105-9432
Mailing Address - Country:US
Mailing Address - Phone:806-242-7782
Mailing Address - Fax:806-553-7383
Practice Address - Street 1:6101 43RD ST STE C
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-3750
Practice Address - Country:US
Practice Address - Phone:800-658-6046
Practice Address - Fax:806-553-7383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX321012Medicaid