Provider Demographics
NPI:1669661237
Name:SPECIALTY PHARMACIES INC
Entity Type:Organization
Organization Name:SPECIALTY PHARMACIES INC
Other - Org Name:2ND STREET PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-547-6520
Mailing Address - Street 1:1660 WALT WHITMAN RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4159
Mailing Address - Country:US
Mailing Address - Phone:631-547-6520
Mailing Address - Fax:631-249-5863
Practice Address - Street 1:465 2ND STREET
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607
Practice Address - Country:US
Practice Address - Phone:510-835-0774
Practice Address - Fax:510-628-0415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy