Provider Demographics
NPI:1184679177
Name:SPECIALIZED PHARMACY SERVICES, INC.
Entity Type:Organization
Organization Name:SPECIALIZED PHARMACY SERVICES, INC.
Other - Org Name:SPECIALTY SHOES & DIABETIC SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:C
Authorized Official - Last Name:FLANAKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-832-8750
Mailing Address - Street 1:PO BOX 7380
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77726-7380
Mailing Address - Country:US
Mailing Address - Phone:409-832-8750
Mailing Address - Fax:409-866-7996
Practice Address - Street 1:7645 PHELAN BLVD
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-5753
Practice Address - Country:US
Practice Address - Phone:409-832-8750
Practice Address - Fax:409-866-7996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX515247OtherBLUE CROSS BLUE SHIELD
TX087291301Medicaid
TX016053301Medicaid
TX515247OtherBLUE CROSS BLUE SHIELD