Provider Demographics
NPI:1629653027
Name:MD SPECIALTY PHARMACY
Entity Type:Organization
Organization Name:MD SPECIALTY PHARMACY
Other - Org Name:MD SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:281-528-3271
Mailing Address - Street 1:2504 BOULDER CREEK CT
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-9736
Mailing Address - Country:US
Mailing Address - Phone:281-528-3271
Mailing Address - Fax:
Practice Address - Street 1:1300 BAY AREA BLVD STE B230
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2505
Practice Address - Country:US
Practice Address - Phone:346-230-7984
Practice Address - Fax:281-747-1554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-17
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy