Provider Demographics
NPI:1508028390
Name:SPECIALTY PHARMACIES INC
Entity Type:Organization
Organization Name:SPECIALTY PHARMACIES INC
Other - Org Name:MOMS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:TEMPESTA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:631-547-6520
Mailing Address - Street 1:PO BOX 637308
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-7308
Mailing Address - Country:US
Mailing Address - Phone:206-568-2486
Mailing Address - Fax:206-568-3233
Practice Address - Street 1:1017 E UNION ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-3824
Practice Address - Country:US
Practice Address - Phone:206-568-2486
Practice Address - Fax:206-568-3233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
WACF600291403336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4933087OtherNCPDP PROVIDER IDENTIFICATION NUMBER