Provider Demographics
NPI:1386226306
Name:SPECIALTY PHARMA SAI INC
Entity Type:Organization
Organization Name:SPECIALTY PHARMA SAI INC
Other - Org Name:MKT SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIJAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAXMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-590-0056
Mailing Address - Street 1:15642 SAND CANYON AVE UNIT 53871
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92619-5430
Mailing Address - Country:US
Mailing Address - Phone:949-590-0056
Mailing Address - Fax:619-333-2525
Practice Address - Street 1:4153B UNIVERSITY AVE, SUITE B
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-1421
Practice Address - Country:US
Practice Address - Phone:949-590-0056
Practice Address - Fax:619-333-2525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-28
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1386226306Medicaid
5674812OtherNCPDP
CAPHY58096OtherCALIFORNIA BOARD OF PHARMACY