Provider Demographics
NPI:1679042105
Name:EXCELMED SPECIALTY PHARMACY, LLC
Entity Type:Organization
Organization Name:EXCELMED SPECIALTY PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLIN DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:OJI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, BCPP
Authorized Official - Phone:301-332-4348
Mailing Address - Street 1:4654 HIGHWAY 6 N STE 204
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-2878
Mailing Address - Country:US
Mailing Address - Phone:713-291-0954
Mailing Address - Fax:
Practice Address - Street 1:4654 HIGHWAY 6 N STE 204
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-2878
Practice Address - Country:US
Practice Address - Phone:713-291-0954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX32300OtherTEXAS STATE BOARD OF PHARMACY