Provider Demographics
NPI:1083099485
Name:PARAGON SPECIALTY PHARMACY, LLC
Entity Type:Organization
Organization Name:PARAGON SPECIALTY PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ULFAT
Authorized Official - Middle Name:U
Authorized Official - Last Name:NISA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:855-355-3552
Mailing Address - Street 1:2920 MOTLEY DR
Mailing Address - Street 2:SUITE 800
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150
Mailing Address - Country:US
Mailing Address - Phone:855-355-3552
Mailing Address - Fax:855-355-3554
Practice Address - Street 1:2920 MOTLEY DR
Practice Address - Street 2:SUITE 800
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150
Practice Address - Country:US
Practice Address - Phone:855-355-3552
Practice Address - Fax:855-355-3554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-27
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX300723336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy