Provider Demographics
NPI:1508123969
Name:SPECIALTY PHARMACEUTICAL SOLUTIONS, LLC
Entity Type:Organization
Organization Name:SPECIALTY PHARMACEUTICAL SOLUTIONS, LLC
Other - Org Name:GULF COAST PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CLINT
Authorized Official - Middle Name:
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-851-7506
Mailing Address - Street 1:1838 ELM HILL PIKE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37210-3726
Mailing Address - Country:US
Mailing Address - Phone:855-567-3432
Mailing Address - Fax:888-208-1097
Practice Address - Street 1:6550 MAPLERIDGE ST
Practice Address - Street 2:SUITE 222
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-4600
Practice Address - Country:US
Practice Address - Phone:855-567-3432
Practice Address - Fax:888-208-1097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX278933336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy