PANTHERX SPECIALTY LLC

Provider Demographics

• NPI: 1659762524
• Name: PANTHERX SPECIALTY LLC
• Entity Type: Organization
• Organization Name: PANTHERX SPECIALTY LLC
• Other - Org Name: PANTHERX SPECIALTY PHARMACY
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: CEO
• Authorized Official - First Name: ROBERT
• Authorized Official - Last Name: SNYDER
• Authorized Official - Phone: 855-726-8479
• Mailing Address - Street 1: 24 SUMMIT PARK DR
• Mailing Address - Street 2: SUITE 101
• Mailing Address - City: PITTSBURGH
• Mailing Address - State: PA
• Mailing Address - Zip Code: 15275-1104
• Mailing Address - Country: US
• Mailing Address - Phone: 855-726-8479
• Mailing Address - Fax: 855-246-3986
• Practice Address - Street 1: 24 SUMMIT PARK DR STE 101
• Practice Address - City: PITTSBURGH
• Practice Address - State: PA
• Practice Address - Zip Code: 15275-1104
• Practice Address - Country: US
• Practice Address - Phone: 855-726-8479
• Practice Address - Fax: 855-246-3986
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2015-02-12
• Last Update Date: 2023-10-09

Provider Licenses

State	License ID	Taxonomies
		333600000X
PA	PP482247	3336S0011X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	3336S0011X	Suppliers	Pharmacy	Specialty Pharmacy
No	333600000X	Suppliers	Pharmacy

Provider Identifiers

State	Identifier ID	ID Type	Issuer
GA	003169018A	Medicaid
MS	004521280	Medicaid
PR	038969000	Medicaid
NE	10026461101	Medicaid
AL	179064	Medicaid
LA	3535998	Medicaid
NJ	0484733	Medicaid
WY	151723600	Medicaid
IA	1659762524	Medicaid
AZ	089545	Medicaid
MI	1659762524	Medicaid
KS	201105430A	Medicaid
WI	1659762524	Medicaid
TX	1659762524	Medicaid
KY	7100341470	Medicaid
HI	003572	Medicaid
DC	014205031	Medicaid
MT	100031262	Medicaid
DE	250630465	Medicaid
IN	300005702	Medicaid
UT	3005296	Medicaid
NM	4772202	Medicaid
OH	0108012	Medicaid
MA	110105692A	Medicaid
FL	115359800	Medicaid
OK	200566670A	Medicaid
AR	211567407	Medicaid
VA	30015069640004	Medicaid
MO	600027164	Medicaid
SC	7P224D	Medicaid
NV	100549623	Medicaid
NH	3129668	Medicaid
TN	Q044073	Medicaid
ME	1659762524	Medicaid
NC	1659762524	Medicaid
WA	2068423	Medicaid
OR	500745115	Medicaid
CO	9000154762	Medicaid