Provider Demographics
NPI:1275785743
Name:PHARMACEUTICAL SPECIALTIES INC
Entity Type:Organization
Organization Name:PHARMACEUTICAL SPECIALTIES INC
Other - Org Name:PSI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARMACY
Authorized Official - Phone:800-818-6486
Mailing Address - Street 1:150 CLEVELAND RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BOGART
Mailing Address - State:GA
Mailing Address - Zip Code:30622-1701
Mailing Address - Country:US
Mailing Address - Phone:706-369-9591
Mailing Address - Fax:706-369-9698
Practice Address - Street 1:958 MCEVER RD
Practice Address - Street 2:SUITE B-8
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30504-3972
Practice Address - Country:US
Practice Address - Phone:800-818-6486
Practice Address - Fax:800-818-6490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0095063336C0003X
NC102573336C0004X
3336H0001X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1275785743Medicaid
NC0116901Medicaid
1157848OtherNCPDP PROVIDER IDENTIFICATION NUMBER