Provider Demographics
NPI:1598872210
Name:PHARMACEUTICAL SPECIALTIES LLC
Entity Type:Organization
Organization Name:PHARMACEUTICAL SPECIALTIES LLC
Other - Org Name:MAXOR SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT PHARMACY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-242-7782
Mailing Address - Street 1:PO BOX 1353
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79105-1353
Mailing Address - Country:US
Mailing Address - Phone:806-242-7782
Mailing Address - Fax:706-621-7263
Practice Address - Street 1:150 CLEVELAND RD STE B
Practice Address - Street 2:
Practice Address - City:BOGART
Practice Address - State:GA
Practice Address - Zip Code:30622-1701
Practice Address - Country:US
Practice Address - Phone:800-818-6486
Practice Address - Fax:706-369-9591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X, 3336S0011X
IN64001645A3336C0003X
IL0540201943336C0003X
GAPHHH0000533336C0003X
KYGA18193336C0003X
HIPMP13753336C0003X
ID44091MS3336C0003X
KS22-1015893336C0003X
AZY0070573336C0003X
COOSP.00063083336C0003X, 3336C0003X
AK1177703336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVA010169101Medicaid
2015157OtherPK
GA000710542EMedicaid
SC7G8718Medicaid
SC60008112OtherSC NON RESIDENT RX PERMIT
GA1110730002Medicare NSC
VA0214000901OtherVA RX PERMIT
AL201145OtherAL OUT OF STATE RX PERMIT
NC08269OtherNC RX PERMIT
SC7G8718Medicaid