Provider Demographics
NPI:1427588805
Name:UNIVERSAL SPECIALTY PHARMACY LLC
Entity Type:Organization
Organization Name:UNIVERSAL SPECIALTY PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUPRIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-900-8414
Mailing Address - Street 1:5555 OAKBROOK PARKWAY
Mailing Address - Street 2:BUILDING 100, SUITE 110
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093
Mailing Address - Country:US
Mailing Address - Phone:855-900-8414
Mailing Address - Fax:470-300-7664
Practice Address - Street 1:5555 OAKBROOK PKWY STE 110
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-2268
Practice Address - Country:US
Practice Address - Phone:855-900-8414
Practice Address - Fax:470-300-7664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-18
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA333600000X, 3336S0011X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy