Provider Demographics
NPI:1235187956
Name:SPECIALTY PHARMACIES INC
Entity Type:Organization
Organization Name:SPECIALTY PHARMACIES INC
Other - Org Name:MOMS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:TEMPESTA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:631-547-6520
Mailing Address - Street 1:4071 18TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-2535
Mailing Address - Country:US
Mailing Address - Phone:415-255-2720
Mailing Address - Fax:415-255-0937
Practice Address - Street 1:4071 18TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-2535
Practice Address - Country:US
Practice Address - Phone:415-255-2720
Practice Address - Fax:415-255-0937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY501653336C0003X
3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA473350Medicaid
5617305OtherNCPDP PROVIDER IDENTIFICATION NUMBER