Provider Demographics
NPI:1538128947
Name:MCKESSON SPECIALTY PHARMACEUTICALS LLC
Entity Type:Organization
Organization Name:MCKESSON SPECIALTY PHARMACEUTICALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:NIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-613-2909
Mailing Address - Street 1:5712 JARVIS STREET
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70123-2222
Mailing Address - Country:US
Mailing Address - Phone:504-736-7827
Mailing Address - Fax:504-736-0926
Practice Address - Street 1:5712 JARVIS ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70123-2222
Practice Address - Country:US
Practice Address - Phone:504-736-7827
Practice Address - Fax:504-736-0926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4767-IR183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0553354Medicaid
KS6087520401Medicaid
DE1000006597Medicaid
MI1928108Medicaid
NJ0022292Medicaid
CO28202058Medicaid
MS330693Medicaid
KY54003421Medicaid
LA1269336Medicaid
AZ685084Medicaid
AKPH712LAMedicaid
KS6087520401Medicaid
KS6087520401Medicaid