Provider Demographics
NPI:1417334152
Name:SPS SPECIALTY PHARMACY SERVICES
Entity Type:Organization
Organization Name:SPS SPECIALTY PHARMACY SERVICES
Other - Org Name:SPS SPECIALTY PHARMACY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICEPRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:MILDRED
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-704-2025
Mailing Address - Street 1:75 AVE LUIS MUNOZ MARIN
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-3856
Mailing Address - Country:US
Mailing Address - Phone:787-704-2025
Mailing Address - Fax:787-704-2027
Practice Address - Street 1:75 AVE LUIS MUNOZ MARIN
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-3856
Practice Address - Country:US
Practice Address - Phone:787-704-2025
Practice Address - Fax:787-704-2027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15F3174261QI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5846350001Medicare PIN