Provider Demographics
NPI:1265464705
Name:PHARMACEUTICAL SPECIALTIES LLC
Entity Type:Organization
Organization Name:PHARMACEUTICAL SPECIALTIES LLC
Other - Org Name:PSI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT-MARKET STRATEGY
Authorized Official - Prefix:
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:
Authorized Official - Last Name:HALSNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-242-7782
Mailing Address - Street 1:320 S POLK ST STE 800
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79101-1429
Mailing Address - Country:US
Mailing Address - Phone:806-242-7782
Mailing Address - Fax:806-324-5495
Practice Address - Street 1:150 CLEVELAND RD
Practice Address - Street 2:STE A
Practice Address - City:BOGART
Practice Address - State:GA
Practice Address - Zip Code:30622-1701
Practice Address - Country:US
Practice Address - Phone:706-369-9591
Practice Address - Fax:706-369-9698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X
GAPHHH0000643336C0003X, 3336C0003X
WVMO05602833336C0003X
FLPH226913336C0004X
GAPHHH0000543336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00710542BMedicaid
GA00710542AMedicaid
2019543OtherPK
GA00710542AMedicaid
GA00710542AMedicaid
NC0609367Medicaid
SC7G7963Medicaid