PANTHERX SPECIALTY LLC

Provider Demographics

• NPI: 1316213531
• Name: PANTHERX SPECIALTY LLC
• Entity Type: Organization
• Organization Name: PANTHERX SPECIALTY LLC
• Other - Org Name: PANTHERX SPECIALTY PHARMACY
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: CEO
• Authorized Official - First Name: ROBERT
• Authorized Official - Last Name: SNYDER
• Authorized Official - Phone: 855-726-8479
• Mailing Address - Street 1: 24 SUMMIT PARK DR
• Mailing Address - Street 2: SUITE 101
• Mailing Address - City: PITTSBURGH
• Mailing Address - State: PA
• Mailing Address - Zip Code: 15275-1104
• Mailing Address - Country: US
• Mailing Address - Phone: 855-726-8479
• Mailing Address - Fax: 855-246-3986
• Practice Address - Street 1: 24 SUMMIT PARK DR
• Practice Address - Street 2: SUITE 101
• Practice Address - City: PITTSBURGH
• Practice Address - State: PA
• Practice Address - Zip Code: 15275
• Practice Address - Country: US
• Practice Address - Phone: 855-726-8479
• Practice Address - Fax: 855-246-3986
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2012-04-02
• Last Update Date: 2023-10-09

Provider Licenses

State	License ID	Taxonomies
		251F00000X, 333600000X, 3336C0003X
PA	PP482247	3336S0011X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	3336S0011X	Suppliers	Pharmacy	Specialty Pharmacy
No	251F00000X	Agencies	Home Infusion
No	333600000X	Suppliers	Pharmacy
No	3336C0003X	Suppliers	Pharmacy	Community/Retail Pharmacy

Provider Identifiers

State	Identifier ID	ID Type	Issuer
VT	10244270001	Medicaid
ID	1316213531	Medicaid
LA	2208331	Medicaid
NH	3129668	Medicaid
MD	542113600	Medicaid
NJ	0484733	Medicaid
WI	100043114	Medicaid
CT	1316213531	Medicaid
SD	2014364	Medicaid
NM	9828541	Medicaid
NV	100539753	Medicaid
MI	1316213531	Medicaid
WA	2049045	Medicaid
CO	44674279	Medicaid
OR	500681864	Medicaid
FL	014478100	Medicaid
AZ	089545	Medicaid
UT	1316213531	Medicaid
CA	1316213531	Medicaid
RI	1316213531	Medicaid
AK	1626551	Medicaid
IN	201264310A	Medicaid
PA	102702417-0002	Medicaid
WV	1316213531	Medicaid
DE	250630455	Medicaid
KY	7100341470	Medicaid
NC	1316213531	Medicaid
ND	1486930	Medicaid
OK	200566670A	Medicaid
NY	3971780	Medicaid
SC	7P2247	Medicaid
MS	01236278	Medicaid
HI	1316213531	Medicaid
ME	1316213531	Medicaid
MN	1316213531	Medicaid
TN	Q044074	Medicaid
MT	100030597	Medicaid
NE	100264611-00	Medicaid
IA	1316213531	Medicaid
VA	3001506964	Medicaid
IN	1316213531	Medicaid
CA	1316213531	Medicaid
NY	3971780	Medicaid
OK	200566670A	Medicaid
NY	3971780	Medicaid