Provider Demographics
NPI:1154841526
Name:ALLIANCE SPECIALTY PHARMACY LLC
Entity Type:Organization
Organization Name:ALLIANCE SPECIALTY PHARMACY LLC
Other - Org Name:ALLIANCE SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRITESH
Authorized Official - Middle Name:
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:248-230-8044
Mailing Address - Street 1:25301 VAN DYKE AVE
Mailing Address - Street 2:
Mailing Address - City:CENTER LINE
Mailing Address - State:MI
Mailing Address - Zip Code:48015-1425
Mailing Address - Country:US
Mailing Address - Phone:248-230-8044
Mailing Address - Fax:248-230-8045
Practice Address - Street 1:25301 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:CENTER LINE
Practice Address - State:MI
Practice Address - Zip Code:48015-1425
Practice Address - Country:US
Practice Address - Phone:248-230-8044
Practice Address - Fax:248-230-8045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-26
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy