Provider Demographics
NPI:1346859071
Name:ENNIS SPECIALTY PHARMACY, INC
Entity Type:Organization
Organization Name:ENNIS SPECIALTY PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:AKHTAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-901-7100
Mailing Address - Street 1:601 S CLAY ST STE 108
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119-5771
Mailing Address - Country:US
Mailing Address - Phone:469-901-7100
Mailing Address - Fax:469-901-7200
Practice Address - Street 1:601 S CLAY ST STE 108
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-5771
Practice Address - Country:US
Practice Address - Phone:469-901-7100
Practice Address - Fax:469-901-7200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy