Provider Demographics
NPI:1053841015
Name:SPECIALTY CARE RX LLC
Entity Type:Organization
Organization Name:SPECIALTY CARE RX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:VA
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:406-531-5888
Mailing Address - Street 1:111 FASHION RD STE ABC
Mailing Address - Street 2:
Mailing Address - City:POUNDING MILL
Mailing Address - State:VA
Mailing Address - Zip Code:24637-1200
Mailing Address - Country:US
Mailing Address - Phone:276-345-0284
Mailing Address - Fax:276-345-9356
Practice Address - Street 1:111 FASHION RD STE ABC
Practice Address - Street 2:
Practice Address - City:POUNDING MILL
Practice Address - State:VA
Practice Address - Zip Code:24637-1200
Practice Address - Country:US
Practice Address - Phone:276-345-0284
Practice Address - Fax:276-345-0284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-13
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201004783333600000X, 3336C0004X, 3336M0002X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy