Provider Demographics
NPI:1275675167
Name:SPECIALIZED RX, INC
Entity Type:Organization
Organization Name:SPECIALIZED RX, INC
Other - Org Name:SPECIALIZED PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FANNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-987-8500
Mailing Address - Street 1:1416 N SAM HOUSTON PKWY E
Mailing Address - Street 2:STE 160
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77032-2960
Mailing Address - Country:US
Mailing Address - Phone:281-987-8500
Mailing Address - Fax:
Practice Address - Street 1:1416 N SAM HOUSTON PKWY E
Practice Address - Street 2:STE 160
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77032-2960
Practice Address - Country:US
Practice Address - Phone:281-987-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX253093336C0003X, 3336C0004X, 3336L0003X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Not Answered3336C0004XSuppliersPharmacyCompounding Pharmacy
Not Answered3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Not Answered3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144678Medicaid
TX25309OtherTX STATE BOARD PHARMACY
TX144678Medicaid