Provider Demographics
NPI:1083996375
Name:DOCTORS SPECIALTY PHARMACY LLC
Entity Type:Organization
Organization Name:DOCTORS SPECIALTY PHARMACY LLC
Other - Org Name:DOCTORS SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-528-7197
Mailing Address - Street 1:8600 FREEPORT PKWY STE 110A
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-2575
Mailing Address - Country:US
Mailing Address - Phone:469-906-2002
Mailing Address - Fax:469-454-1693
Practice Address - Street 1:8600 FREEPORT PKWY STE 110
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-1988
Practice Address - Country:US
Practice Address - Phone:469-906-2002
Practice Address - Fax:469-454-1693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-13
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27846333600000X, 3336C0004X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2132885OtherPK