Provider Demographics
NPI:1578102976
Name:FUSION RX SPECIALTY PHARMACY, LLC
Entity Type:Organization
Organization Name:FUSION RX SPECIALTY PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:SUNJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-850-8502
Mailing Address - Street 1:3848 N TARRANT PKWY STE 150
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-5424
Mailing Address - Country:US
Mailing Address - Phone:817-562-7871
Mailing Address - Fax:
Practice Address - Street 1:3848 N TARRANT PKWY STE 150
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-5424
Practice Address - Country:US
Practice Address - Phone:817-562-7871
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy